Abstract
Purpose :
To determine the rate of progressive visual field loss and associated risk factors among African-Americans with primary open angle glaucoma (POAG)
Methods :
African American patients with POAG and at least 6 visual field tests and three years of follow up were included. Disease progression was defined as follows: mean deviation (MD) slope with a rate of change ≤-0.5 dB/year, pointwise linear regression (PLR) having at least three locations with a significant slope of ≤-1 dB/year, and glaucoma rate index (GRI) <-6. The following data were collected by medical record review: demographics, medical and ocular history, central corneal thickness (CCT), visual acuity (VA), intraocular pressure (IOP), glaucoma medication, new ocular conditions, and surgery.
Results :
349 eyes of 191 patients were included; 113 patients (59.2%) were female. Median age at presentation was 65 years (IQR:14.9) and median duration of follow up was 12.8±10.5 years. The median body mass index was 26.1±6.7. Hypertension (131 patients, 68.6%), diabetes (66 patients, 34.6%) and migraine (6 patients, 3.1%) were the main systemic comorbidities; 98 (51.3%) patients had a family history of glaucoma. Median central corneal thickness at baseline was 541±52 µm and median IOP was 13.9±3.4 mmHg.
The rates of progression of glaucomatous damage were 13% (MD), 19% (PLR), and 23% (GRI). 42 eyes were considered progressors and 257 eyes non-progressors by all three models. RNFL thickness both at baseline and final follow-up was significantly lower in eyes with progressive damage (66±14µm vs 80±22µm in non-progressors, p=0.00; 63±19 µm vs 74±24 µm in non-progressors, p=0.00, respectively). Conversely, number of medication at baseline 2.2± 1.5 (p=0.00) and most recent visit 1.1± 1.5 (p=0.00) was significantly higher in eyes with progressive damage.
Risk factors for progression identified by all three models include higher peak IOP (p=0.00) and older age at most recent visit (p=0.00). The PLR model revealed 65% of eyes with progressive damage had a family history of glaucoma compared to 54% without progression (p=0.04).
Conclusions :
Over a period of 13 years, about one fifth of eyes had progressive damage under treatment. Family history, high peak IOP, and aging were identified as risk factors for progression.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.