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Bruna Melchior Silva, C Gustavo De Moraes, Jayter Silva Paula, George A Cioffi, Christopher A Girkin, Massimo A Fazio, James Alexander Proudfoot, Robert N Weinreb, Linda M Zangwill, Jeffrey M Liebmann; Intraocular Pressure and Rates of Visual Field Progression in The African Descent and Glaucoma Evaluation Study (ADAGES). Invest. Ophthalmol. Vis. Sci. 2020;61(7):4259.
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© ARVO (1962-2015); The Authors (2016-present)
A recent study (Gracitelli et al, JAMA 2018) showed that visual field (VF) progression was less likely to be detected in persons of African descent (AD) compared to European descent (ED), due in part to higher VF variability among patients of AD. The purpose of this study is to determine how treatment effects may help explain differences in rates of VF progression between AD and ED in a prospective longitudinal study (ADAGES).
11,055 24-2 VF tests of 878 eyes with glaucomatous optic neuropathy and VF damage were analyzed. Only patients with ≥5 visits and ≥2 years of follow-up were included. MD slopes (dB) over time were calculated with mixed effects models. The following treated IOP parameters were assessed: baseline, peak, mean and standard deviation (SD).
There was no significant difference in baseline VF MD or rates of VF progression between AD and ED patients (Table). However, AD patients tended to have lower treated IOP parameters and thinner corneas (Table). There was a significant relationship between mean IOP and rates of MD progression adjusted for CCT in both AD and ED individuals (-.03 [-.05 to -.02] vs -.01 [-.02 to -.01], dB/year faster per 1 mmHg higher IOP, respectively, p = 0.008) suggesting that AD eyes progress faster for each 1 mmHg higher mean IOP. The difference in rates of MD progression between AD and ED individuals was not significant in eyes with mean IOP < 15 mmHg (.00 [-.03 to .04] vs -.02 [-.04 to -.008], dB/year faster per 1 mmHg higher IOP (p=0.183).
In ADAGES, ED and AD patients progressed at similar rates, in part because AD patients had lower treated IOP and were more sensitive to IOP changes. The close monitoring and low treated IOP in this prospective study may have helped mitigate disparities in rates of progression between racial groups seen in the real-world.
This is a 2020 ARVO Annual Meeting abstract.
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