Progression to severe visual impairment and blindness in POAG patients: pace and risk factors—a cohort study using German health claims data

Abstract

ObjectiveGlaucoma is a leading cause of severe visual impairment and blindness (SVI/B) worldwide. Hence, it is of utmost importance to explore relevant risk factors and study the pace of progression to SVI/B.Methods and analysisWe used a random sample of 250 000 persons from administrative individual-level health records of the Allgemeine Ortskrankenkassen between 2004 and 2015. We identified 3535 primary open-angle glaucoma (POAG) patients aged 55 and older and followed them for up to 10 years. Monocular and binocular SVI/B were defined by the ICD-10 classifications H54.0 and H54.4. Ophthalmological and chronic disease risk factors were analysed by applying a multivariable Cox proportional hazard model.ResultsThe risk of SVI/B in POAG patients was significantly increased by the presence of specific additional eye diseases such as secondary glaucoma (HR: 3.08, p<0.001), retinal vascular occlusion (HR: 3.00, p<0.001) or age-related macular degeneration (AMD) (HR: 2.26, p<0.001). The risk was highest in the first 2 years after the POAG diagnosis and significantly decreased after the fifth year (HR: 0.36, p=0.002). Ocular injuries, other ocular diseases, non-ophthalmological comorbidities, and age and sex had no significant influence (p>0.05).ConclusionAlthough progression to SVI/B is relatively rare in POAG patients in Germany, one must be aware of additional risk factors, such as secondary glaucoma, retinal vascular occlusion and AMD. Regular ophthalmological examinations help prevent the progression of SVI/B, especially in the first years after the POAG diagnosis. Specific, targeted, and timely treatments for the other eye diseases could help prevent or delay SVI/B.

ISK Factors for Progressive Visual Field Loss in Primary Open-Angle Glaucoma: A Retrospective Cross-Sectional Study

“…A study of open-angle glaucoma patients in Italy discovered that characteristics such as family history, myopia, diabetes, and systemic hypertension were linked to bilateral VF damage [18]. According to a Swedish study, the presence of particular additional eye disorders such as secondary glaucoma, retinal vascular occlusion, or age-related macular degeneration enhanced the likelihood of severe vision loss and blindness in POAG patients [19].…”

ISK Factors for Progressive Visual Field Loss in Primary Open-Angle Glaucoma: A Retrospective Cross-Sectional Study

“…A study of open-angle glaucoma patients in Italy discovered that characteristics such as family history, myopia, diabetes, and systemic hypertension were linked to bilateral VF damage [18]. According to a Swedish study, the presence of particular additional eye disorders such as secondary glaucoma, retinal vascular occlusion, or age-related macular degeneration enhanced the likelihood of severe vision loss and blindness in POAG patients [19].…”

Association Between Greater Social Vulnerability and Delayed Glaucoma Surgery

“…Glaucoma is a leading cause of irreversible vision loss nationally and globally. 1 – 4 Ocular risk factors for disease progression include elevated intraocular pressure (IOP) and thinner central corneal thickness (CCT), 5 while demographic risk factors include older age and African ancestry. 6 , 7 Since IOP is the main modifiable risk factor, preventing blindness typically involves IOP reduction, which is typically achieved with laser or topical medications initially, followed by surgical intervention if IOP reduction is deemed insufficient.…”

Association between optic atrophy 1 polymorphisms and primary open angle glaucoma risk: Based on a meta-analysis

“…2 POAG is the most common subtype of glaucoma, accounting for approximately three-fives (58.9% of 58.9 million) of all glaucoma cases in 2020, and is the main cause of blindness in glaucoma patients. 3 Moreover, POAG can be categorized into high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) according to the height of the ocular partial pressure at the time of onset. 4 Many epidemiological studies have suggested that many factors, including intraocular pressure (IOP), myopia, race, age, genetic mutation, immune disorders, smoking or drinking, and diabetes mellitus are the main risk factors for POAG.…”

ISK Factors for Progressive Visual Field Loss in Primary Open-Angle Glaucoma: A Retrospective Cross-Sectional Study

“…A study of open-angle glaucoma patients in Italy discovered that characteristics such as family history, myopia, diabetes, and systemic hypertension were linked to bilateral VF damage [18]. According to a Swedish study, the presence of particular additional eye disorders such as secondary glaucoma, retinal vascular occlusion, or age-related macular degeneration enhanced the likelihood of severe vision loss and blindness in POAG patients [19].…”

Association Between Greater Social Vulnerability and Delayed Glaucoma Surgery

“…Glaucoma is a leading cause of irreversible vision loss nationally and globally. 1 – 4 Ocular risk factors for disease progression include elevated intraocular pressure (IOP) and thinner central corneal thickness (CCT), 5 while demographic risk factors include older age and African ancestry. 6 , 7 Since IOP is the main modifiable risk factor, preventing blindness typically involves IOP reduction, which is typically achieved with laser or topical medications initially, followed by surgical intervention if IOP reduction is deemed insufficient.…”

Association between optic atrophy 1 polymorphisms and primary open angle glaucoma risk: Based on a meta-analysis

“…2 POAG is the most common subtype of glaucoma, accounting for approximately three-fives (58.9% of 58.9 million) of all glaucoma cases in 2020, and is the main cause of blindness in glaucoma patients. 3 Moreover, POAG can be categorized into high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) according to the height of the ocular partial pressure at the time of onset. 4 Many epidemiological studies have suggested that many factors, including intraocular pressure (IOP), myopia, race, age, genetic mutation, immune disorders, smoking or drinking, and diabetes mellitus are the main risk factors for POAG.…”

ISK Factors for Progressive Visual Field Loss in Primary Open-Angle Glaucoma: A Retrospective Cross-Sectional Study

“…A study of open-angle glaucoma patients in Italy discovered that characteristics such as family history, myopia, diabetes, and systemic hypertension were linked to bilateral VF damage [18]. According to a Swedish study, the presence of particular additional eye disorders such as secondary glaucoma, retinal vascular occlusion, or age-related macular degeneration enhanced the likelihood of severe vision loss and blindness in POAG patients [19].…”

Association Between Greater Social Vulnerability and Delayed Glaucoma Surgery

“…Glaucoma is a leading cause of irreversible vision loss nationally and globally. 1 – 4 Ocular risk factors for disease progression include elevated intraocular pressure (IOP) and thinner central corneal thickness (CCT), 5 while demographic risk factors include older age and African ancestry. 6 , 7 Since IOP is the main modifiable risk factor, preventing blindness typically involves IOP reduction, which is typically achieved with laser or topical medications initially, followed by surgical intervention if IOP reduction is deemed insufficient.…”

Association between optic atrophy 1 polymorphisms and primary open angle glaucoma risk: Based on a meta-analysis

“…2 POAG is the most common subtype of glaucoma, accounting for approximately three-fives (58.9% of 58.9 million) of all glaucoma cases in 2020, and is the main cause of blindness in glaucoma patients. 3 Moreover, POAG can be categorized into high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) according to the height of the ocular partial pressure at the time of onset. 4 Many epidemiological studies have suggested that many factors, including intraocular pressure (IOP), myopia, race, age, genetic mutation, immune disorders, smoking or drinking, and diabetes mellitus are the main risk factors for POAG.…”