Abstract
Purpose :
Blindness and severity of vision loss are known to impact mortality. However, the relationship between peripheral vision loss and mortality remains unclear. This retrospective chart-review study aims to test our hypothesis that primary open angle glaucoma (POAG) severity impacts overall mortality.
Methods :
We included patients with POAG aged over 80 years at the Emory Eye Clinic from 2015-2016 (n=194). Exclusions were made for individuals with unreliable (reliability indices >33%) Humphrey visual fields (n=130), secondary glaucomas (n=23), and missing comorbidity or visual acuity (VA) data (n=18). Age, VA, race, gender, better eye visual field index (VFI) and calculated Charlson comorbidity index (CCI) were based on data from electronic medical records. Subjects were categorized based on glaucoma severity in better eye: mild (VFI≥95) and moderate-severe (VFI<95) and comorbidities: CCI=4 (indicating no comorbidities), 5-6, and 7+. CDC National Death Index (NDI) determined the subjects’ vital status on Dec 31, 2022. Univariate analysis and logistic regression were employed to assess the predictors of mortality.
Results :
By Dec 31, 2022, 122 glaucoma subjects were alive and 69 were dead. Analysis (table 1) revealed significant differences between those alive and dead in terms of age, CCI, and gender with no significant difference in glaucoma severity, VA, and race. Males (n=75) compared to females (n=116) were not significantly (p<0.05) older (85±4 vs 85±4) but had higher CCI scores (6.5±1.8 vs 5.8±1.7) and mortality rates (51% vs 27%).
Logistic regression was performed to evaluate the effect of age, race, gender, CCI, VA and VFI on mortality. The model was significant (χ2(5) = 25.7, p =0.001). Increasing age and male gender were both independently predictive of mortality. Race, CCI, better eye VA and better eye VFI were not significant predictors in the model.
Subjects with mild glaucoma (n=134) and moderate-severe glaucoma (n=57) were not significantly different in mortality (34.3% vs 40.35%) race gender, CCI, or VA but had significant (t test, p<0.05) differences in age (84±4 vs 86±4 years) and VFI (98±2 vs 80±19) as expected.
Conclusions :
Our findings suggest that among those over 80 years old, glaucoma severity is not a strong predictor of mortality. However, additional studies of outcomes related to functional limitations or quality of life may be warranted to optimize independence among persons with glaucoma in late life.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.