Abstract
Purpose :
To evaluate ocular characteristics of eyes that developed severe visual impairment (SVI) due to glaucoma using a large electronic health record (EHR) database.
Methods :
In this retrospective cohort study, pseudophakic eyes with glaucoma or suspected of glaucoma were identified in the Bascom Palmer Glaucoma Repository with ICD coding. If an eye was diagnosed with a confounding ocular condition (e.g., macular degeneration), all ocular data following the first date of diagnosis were excluded. SVI was defined as best-corrected visual acuity 20/200 or worse at the last two visits but not at the initial visit, with ≥3 months of follow-up. Control eyes were defined as those that met inclusion criteria but did not develop SVI. Ocular and demographic data of both groups were extracted from Epic EHR Systems. Glaucoma surgery was defined as trabeculectomy, tube shunt insertion, cyclophotocoagulation, or standalone microinvasive glaucoma surgery. Statistical comparisons were completed using Fisher exact test and Wilcoxon signed-rank test.
Results :
A total of 142 eyes (1.4%) from 139 patients (2.1%) developed SVI which occurred after 2.4±2.1 years. The control group consisted of 9,755 eyes from 6,578 patients. The overall follow-up period was 4.39±2.23 years for SVI eyes and 3.85±2.30 years for control eyes (p=0.003); SVI occurred after 2.40±2.10 years in the SVI group. A total of 66.9% & 80.4% of SVI and control eyes respectively had a mean IOP ≤18 mmHg during follow-up (p=0.002; Fig. 1). Among eyes with advanced disease at baseline, only 46.3% & 58.8% of SVI and control eyes respectively had mean IOP ≤15 mmHg (p=0.019). A total of 47 SVI eyes (33.1%) and 916 control eyes (9.4%) underwent glaucoma surgery (p<0.001). Time from first visit to first glaucoma surgery was greater in the SVI group compared to controls (2.35±2.05 vs 1.85±2.00 years, p=0.04). Median preoperative visual acuity (VA) at the time of first surgery was 20/100 and 20/30 in the SVI and control groups respectively (p <0.001). A total of 20 SVI eyes (42.6%) had VA 20/200 or worse preoperatively.
Conclusions :
In a large diverse database of glaucoma patients, patients that developed SVI demonstrated poor IOP control. Eyes that developed SVI and underwent surgery waited longer to receive surgery and had worse VA preoperatively.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.