Risk Factors Associated with Progression to Blindness from Primary Open-Angle Glaucoma in an African-American Population

Abstract

Purpose To determine the risk factors associated with progression to blindness from primary open-angle glaucoma (POAG) in an African-American population. Methods This study examined 2119 patients enrolled in the Primary Open-Angle African-American Glaucoma Genetics (POAAGG) study. A total of 59 eyes were identified as legally blind as a result of POAG (cases) and were age-and sex-matched to 59 non-blind eyes with glaucoma (controls). Chart reviews were performed to record known and suspected risk factors. Results Cases were diagnosed with POAG at an earlier age than controls (p = 0.005). Of the 59 eyes of cases, 16 eyes (27.1%) presented with blindness at diagnosis. Cases had worse visual acuity (VA) at diagnosis (p < 0.0001), with VA worse than 20/40 conferring a 27 times higher risk of progression to blindness (p = 0.0005). Blind eyes also demonstrated more visual field defects (p = 0.01), higher pretreatment intraocular pressure (IOP; p < 0.0001), and higher cup-to-disc ratio (p = 0.006) at diagnosis. IOP was less controlled in cases, and those with IOP ≥21 mmHg at more than 20% of follow-up visits were 73 times more likely to become blind (p < 0.0001). Cases missed a greater number of appointments per year (p = 0.003) and had non-adherence issues noted in their charts more often than controls (p = 0.03). However, other compliance data did not significantly differ between groups. Conclusion Access to care, initial VA worse than 20/40, and poor control of IOP were the major risk factors associated with blindness from POAG. Future studies should examine earlier, more effective approaches to glaucoma screening as well as the role of genetics in these significantly younger patients who progress to blindness.

Safety and effectiveness of primary transscleral diode laser cyclophotoablation for glaucoma in Nigeria

“…Most glaucoma patients of African ancestry lose vision rapidly if they are not treated or have poor IOP control. 40 In our study the majority of treated eyes either maintained their presenting VA or their acuity improved. The latter has been reported before.…”

Primary Open-Angle Glaucoma Genetics in African Americans

“…A subset of POAAGG patients were screened for legal blindness due to POAG (62). A total of 118 eyes were examined with half legally blind due to POAG and half afflicted with POAG but retaining vision (age- and sex-matched).…”

Identifying risk factors for blindness from primary open-angle glaucoma by race: a case&ndash;control study

“…At presentation, advanced stage of disease and moderate-to-advanced visual field loss are risk factors for developing blindness, 10 – 16 as are higher initial IOP, 10 , 15 – 18 greater cup-to-disc ratio, 11 older age, 10 , 13 and black or nonwhite race. 6 , 8 , 11 Over the course of treatment, glaucoma patients who have gone blind are more likely than non-blind patients to have taken four or more glaucoma medications, 8 changed medications, 14 undergone glaucoma surgery, 8 , 17 had fluctuation in IOP, 12 , 14 , 16 demonstrated poor compliance or follow-up, 11 – 13 , 16 , 17 had more annual visits to an ophthalmologist, 14 taken more visual field tests, 14 had a longer mean duration of disease, 15 and died at an older age. 15 …”