Abstract
Purpose :
To identify factors associated with visual field (VF) progression in glaucoma patients with small and large optic discs.
Methods :
We performed a retrospective review of glaucoma patients with small and large optic discs from the UCLA Stein Glaucoma Division from 1993-2019. Disc size was defined by optical coherence tomography (OCT) or Heidelberg Retinal Tomography (HRT) values with disc area ≤1.3 mm2 (5%) and ≥2.9 mm2 (95%). Patient charts were reviewed for demographics, diabetes, cardiovascular disease, autoimmune disease, glaucoma type, and ocular comorbidities. VF deterioration was measured by the Glaucoma Rate Index (GRI),1 and eyes were categorized into fast (GRI<-6) or slow (GRI>-6) progressors. Logistic regression models were performed with all covariates as predictors and GRI<-6 as the outcome.
Results :
Of 4,505 patients with eligible disc photos, the study population included 331 eyes with small discs (mean GRI=-3.7) and 234 with large discs (mean GRI=-3.8). In small discs, female gender was associated with increased progression (adjusted odds ratio [aOR]=3.14, 95% confidence interval [CI]=1.71,5.99), while other types of glaucoma (versus primary open angle glaucoma) were associated with decreased progression (aOR=0.11, CI=0.02,0.40). In large discs, increased intraocular pressure (IOP) range was associated with increased progression (aOR=1.35, CI=1.12,1.66). Characteristics associated with large discs included vasospastic phenotype2 (aOR=0.37, CI=0.18,0.7) and certain races/ethnicities (Black: aOR=0.05, CI=0.02,0.12; Hispanic: aOR=0.1, CI=0.04,0.24; Asian: aOR=0.23, CI=0.14,0.38; Other: aOR=0.35, CI=0.21,0.6) (aORs calculated as small versus large). Potential associations between some covariates and progression may have been undetected due to low proportions of affected patients and insufficient statistical power.
Conclusions :
Multiple characteristics were associated in glaucoma patients with small and large discs, as well as with their disease progression. Further investigation of discernible glaucoma phenotypes would be beneficial to improve disease prognostication, treatment, and interpretation of complex genetic associations.
References:
1. Caprioli J, et al. A Method to Measure the Rate of Glaucomatous Visual Field Change. Transl Vis Sci Technol. 2018;7(6):14.
2. Alizadeh R, et al. A Phenotype of Primary Open-Angle Glaucoma with Systemic Vasospasm. J Glaucoma. 2018;27(11):987-992.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.