Abstract
Purpose :
Glaucoma is the second leading cause of irreversible blindness in the world. Previous research has shown that individuals with advanced, open-angle glaucoma (OAG) often have difficulty performing activities of daily living, including mobility and reading. The aim of this study was to evaluate the rate at which patients with advanced OAG were referred for low-vision (LV) services.
Methods :
The study comprised a retrospective, cross-sectional study of patients who had advanced OAG and received care at an academic medical center from March 1, 2021 to February 28, 2022. Patient demographics and appointment history were extracted from the electronic record by using a custom reporting tool. Presenting visual acuity (VA), change in best-corrected visual acuity (BCVA) for those patients who attended a LV evaluation, glaucoma severity, and performance on visual field (VF) testing were abstracted from the electronic record. Logistic regression analysis was used to assess the relationship between study variables and the likelihood of referral for LV evaluation.
Results :
Out of 522 patients with advanced OAG, 14 patients were referred for a LV evaluation (2.7%). Patients who were referred tended to be older (84 vs. 77 years, P=0.019), to have worse VA in their better- (0.70 logMAR vs. 0.23 logMAR, P<0.001) and worse-seeing eyes (1.61 vs. 0.72 logMAR, P<0.001), and were just as likely to be female (each 50%). Overall, 88% of all patients with advanced OAG qualified as having LV, including all of those referred for LV evaluations. LV referral correlated with LV status defined by VA (OR 11.238 CI: 3.587-35.205, P<0.001) but not VF loss in the better-seeing eye (OR 0.596, CI: 0.160-2.213, P=0.439). Thirteen of 14 patients referred to LV completed visits (93%). Half of those patients improved in their better-seeing eye after a LV refraction, gaining an average of -0.31±0.24 logMAR and half gained ≥2-lines of VA. In addition, 38% of patients received magnifiers and 15% mobility training.
Conclusions :
Despite evidence that LV services can further improve visual function and vision-related quality of life, many patients with advanced OAG do not receive referrals for those services. Most patients with advanced OAG are at risk of progressive visual disability from their eye disease. The sooner these patients receive LV services, the more they stand to gain from learning to use evolving assistive technologies.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.