Determinants of severity at presentation among young patients with early onset glaucoma

Abstract

Aim:The aim of this study was to evaluate the clinical, socio-economic, and demographic factors associated with the severity at presentation among juvenile primary open angle glaucoma (JOAG) patients.Materials and Methods:Age at diagnosis, family history, baseline intraocular pressure (IOP), access to health-care, socio-economic status, and glaucoma awareness among 80 unrelated JOAG patients presenting between 10 years and 40 years of age were analyzed for their association with the severity at presentation. Severity at presentation was graded based on worse eye visual field using the advanced glaucoma intervention study score and on binocular visual field defects at presentation.Results:Patients with a positive family history presented 4 years earlier (P = 0.045, confidence interval [CI]: 0.09-8.8) compared to those without a family history. Lower socio-economic status (Odds ratio [OR] 5.7, P = 0.01, CI: 1.5-22), and higher baseline IOP (OR 7, P = 0.003, CI: 1.9-26) were associated with severe glaucomatous visual field defect at presentation. A negative family history was associated with a 10 times likelihood of presenting with a severe glaucomatous field defect (OR 0.1, P = 0.007, CI: 0-0.5).Conclusions:Clinical, socio-economic, and demographic factors are contributory to the severity at presentation among young patients with early onset glaucoma. Presence of a family history is associated with an earlier presentation among these patients and a reduced risk of the severe presentation.

Myopia and glaucoma progression among patients with juvenile onset open angle glaucoma: A retrospective follow up study

“…17 Though phenotypically unremarkable when compared with non-familial POAG, familial POAG have been known to present roughly four years earlier than non-familial cases. 50 The main limitation of this study was the small sample size, especially of the PG group. This is because JOAG is a rare disease.…”

“…showed a weak association between positive family history and progression 17 . Though phenotypically unremarkable when compared with non‐familial POAG, familial POAG have been known to present roughly four years earlier than non‐familial cases 50 …”

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“…The more glaucoma is advanced, the higher is the need to target low IOP. 32 , 34 , 35 Therefore, patients with significant glaucomatous damage require a more resolutive intervention to ensure that IOP would be significantly reduced and that residual visual field maintained.…”

“…Likely, patients with early-onset are likely to manifest with glaucoma. 34 In these cases, early intervention with effective, surgical treatment, is recommended to preserve visual functionality and avoid early visual impairment. 36 , 37 Instead, for older patients, more conservative approach based on treatments with a minor alteration of the eye anatomy is preferred.…”

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“…14 JOAG was diagnosed in individuals between the ages of 10 and 40 years with features of POAG. 15,16 PACG was diagnosed based on the presence of greater than 270° of irido-trabecular contact with elevated IOP, optic nerve and visual field damage. 14…”