Abstract
Purpose :
Controversy exists regarding the rate of glaucoma in patients with age-related macular degeneration (AMD). This study aimed to investigate the rate of glaucoma in patients with exudative or non-exudative AMD compared to an age-matched control group.
Methods :
Billing records from a single institution were analyzed from 2015-2018 and patients ≥55 years of age with a diagnosis of exudative or non-exudative AMD were included. Age-matched patients with dry eye syndrome without any AMD diagnosis were included as a control group. The primary outcome measure was the rate of any glaucoma-related diagnosis. Each patient was classified by subtype and severity of glaucoma based upon the most severe diagnosis recorded during the study period. In order to identify potential cases of under-diagnosis of glaucoma patient charts without any glaucoma diagnosis were reviewed for the following clinical characteristics: intraocular pressure (IOP) ≥22 mmHg, a cup-to-disc ratio (CDR) ≥0.6, and/or a CDR difference between eyes of ≥0.2. A chi-square test, one-way analysis of variance, and post-hoc Tukey test were utilized in the statistical analysis (α=0.05).
Results :
Within the study period, 990 age-matched patients with exudative AMD, non-exudative AMD, or dry eye were identified. The rate of diagnosis of any form of glaucoma was significantly lower in patients with exudative AMD (18.5%) compared to non-exudative AMD (27.8%, p<0.001) or the control group (26.6%, p<0.001). Reviewing these medical records found the rate of potential under-diagnosis of glaucoma to be significantly higher among exudative AMD patients (13.94%, n:138) compared to non-exudative AMD patients (6.97%, n:69, p<0.001) and in the control group (6.67%, n:66, p<0.001). Adding patients with these retrospectively identified risk factors to each group eliminated the difference in the rate of glaucoma diagnosis: 26.06% (n:258) for the exudative AMD group, 25.45% (n:252) for the non-exudative AMD group, and 23.33% (n:231) for the control group (n.s.).
Conclusions :
Significantly lower rates of glaucoma, or its suspicion, were identified among exudative AMD patients. Eye care providers should protect against the under-diagnosis of glaucoma by monitoring longitudinal IOP and disc features, supplemented by imaging data when possible, to more accurately determine the presence of glaucoma-risk in AMD patients.
This is a 2020 ARVO Annual Meeting abstract.