Abstract
Purpose :
Retinal vein occlusion (RVO) is a risk factor for the development of open-angle glaucoma (OAG). This study aims to evaluate the rate at which patients with RVOs underwent screening tests for glaucoma.
Methods :
Patients who developed a branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) without a prior history of glaucoma were identified from billing records from 1984 to 2022. Demographic data, type of RVO, concurrent ocular diagnoses, glaucoma severity, and physical exam characteristics were abstracted from the medical record. Patients who were diagnosed with OAG after RVO were age- and gender-matched 2:1 with subjects who were not subsequently diagnosed with glaucoma. The primary outcome for the case-control analysis was the length of time to first screening by visual field (VF) testing or retinal nerve fiber layer (RNFL) imaging.
Results :
In total, 1145 patients were identified to have RVOs, and 51 were subsequently diagnosed with OAG (4.5%) an average of 5.5 ± 6.1 years later. The average age at RVO diagnosis was 65.2 ± 12.9 years; 57% were male, and slightly more than half had CRVOs (57%). At the time of RVO diagnosis, intraocular pressure was higher and cup-to-disc ratio (CDR) larger in the eyes ultimately diagnosed with OAG (18.8 ± 5.0 mmHg vs. 15.6 ± 3.2 mmHg, p<0.001, and CDR 0.51 ± 0.20 vs. 0.31 ± 0.15, p=0.006, respectively). Screening tests for glaucoma were performed at a higher frequency in patients diagnosed with OAG compared to patients who never received this diagnosis (VF 39% vs. 11%, p<0.001, and RNFL imaging 51% vs. 27%, p=0.004, respectively). These tests were obtained on average 2.1 ± 3.1 years (VF testing) and 1.6 ± 3.2 years (RNFL imaging) after RVO diagnosis. At the time of OAG diagnosis, mean deviation of the VF averaged -10.3 db in eyes with a history of RVO compared with -5.6 db in the fellow eyes (p<0.001); by contrast, RNFL thickness was similar between eyes at diagnosis (72 µm vs. 74 µm, p=0.290).
Conclusions :
Despite the well-known association between RVO and OAG, many patients are not assessed for glaucoma risk by means of VF testing or RNFL imaging. Our study found that these screening tests for glaucoma are often performed years after the diagnosis of an RVO, if they are performed at all. Timely appropriate glaucoma testing for patients who have an RVO is vital to avoid delays in OAG diagnosis and preserve vision.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.