Risk Factors for Rapid Glaucoma Disease Progression

Chan, Thomas; Bala, Chandra; Siu, Anna; Wan, Fiona; White, Andrew

doi:10.1016/j.ajo.2017.06.003

Cited by 94 publications

(72 citation statements)

References 61 publications

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“…13,24 The observed proportion of fast progressors in our POAG cohort is also similar to previous studies: defined thresholds for ''fast'' or ''rapid'' progression in published literature range from > _1 to 2 dB/ year loss in MD, and reported prevalence of patients progressing rapidly varies between 3% and 17% in previous studies. [24][25][26][27][28][29] The main strength of our study is the large starting sample size compared to others in the literature. Although only 205 uveitic eyes were included in our final VF progression analysis, a sufficiently large starting sample was required to reach the final 205 included samples.…”

Section: Discussionmentioning

confidence: 98%

Evaluating the Impact of Uveitis on Visual Field Progression Using Large-Scale Real-World Data

Liu

Kelly

Montesano

et al. 2019

American Journal of Ophthalmology

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To compare rates of visual field (VF) loss in uveitis patients with glaucoma against patients with primary open-angle glaucoma (POAG) and explore the association between intraocular pressure (IOP) and rate of VF loss. DESIGN: Retrospective cohort study. METHODS: Anonymized VFs and IOP measurements extracted from the electronic medical records of 5 regionally different glaucoma clinics in England. A total of 205 eyes with diagnosis of uveitis plus glaucoma were compared with 4600 eyes with POAG only. Minimum inclusion criteria were ‡4 visits within a 4-year window. Relative risk (RR) of being a ''rapid progressor'' (mean deviation [MD] loss ‡1.5 dB/year) was calculated. A mixed-effects model (MEM) and a pointwise VF progression analysis of pattern deviation were used to confirm differences between the groups. Longitudinal IOP mean, range, and variability were compared with rate of VF progression. RESULTS: Median (interquartile range) baseline MD in the uveitis and POAG groups was L3.8 (L8.7, L1.5) dB and L3.1 (L6.6, L1.2) dB, respectively. The uveitis and POAG groups had 23 of 205 (11%) and 331 of 4600 (7%) ''rapidly progressing'' eyes, respectively. Ageadjusted RR for ''rapid progression'' in uveitic vs POAG eyes was 1.9 (95% confidence interval: 1.8-2.0). The MEM confirmed that uveitic eyes (L0.49 dB/year) showed higher rates of VF progression than the POAG group (L0.37 dB/year; P < .01). IOP range and variability were higher in the ''rapidly progressing'' uveitic eyes. CONCLUSIONS: Our analysis suggests that VF loss occurs faster in glaucoma patients with uveitis than those without uveitis. The risk of progressing rapidly in glaucoma with uveitis is almost double than in those without uveitis. Early identification of ''rapid progressors'' may enable targeted intervention to preserve visual function in this high-risk group.

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Section: Discussionmentioning

confidence: 98%

Evaluating the Impact of Uveitis on Visual Field Progression Using Large-Scale Real-World Data

Liu

Kelly

Montesano

et al. 2019

American Journal of Ophthalmology

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“…42 Although DH was a significant factor associated with rapid RNFL thinning in the conventional regression analysis, it was not presented as a prognostic factor in the regression tree model. DH is a known strong risk factor for glaucoma progression 13,43,44 and may indicate ongoing glaucomatous damage. [45][46][47] It is possible that that some DH was left undetected between the follow-ups by paucity of optic disc examinations, which have weakened the influence of DH on the rate of RNFL thinning.…”

Section: Discussionmentioning

confidence: 99%

Elucidation of the Strongest Factors Influencing Rapid Retinal Nerve Fiber Layer Thinning in Glaucoma

Lee

Kim

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To determine which groupings of prognostic factors best explain the rapid progressive retinal nerve fiber layer (RNFL) thinning in patients with primary open-angle glaucoma (POAG). METHODS. Optic nerves of 111 POAG patients who were followed for at least 2.5 years, during which the RNFL thickness was measured by serial spectral-domain optical coherence tomography (OCT) were included. Eyes were imaged using enhanced depth-imaging spectraldomain OCT and swept-source OCT angiography to determine the lamina cribrosa curvature index (LCCI), and the presence of a choroidal microvasculature dropout (cMvD), respectively. The rate of RNFL thinning was determined by linear regression of serial OCT RNFL thickness measurements. A regression tree model was used to find groupings of factors that best explain the rate of future RNFL thinning. RESULTS. Disc hemorrhage, larger LCCI, and presence of cMvD were associated with faster global RNFL thinning in the multivariate regression analysis. The regression tree analysis revealed three stratified groups based on the rate of RNFL thinning, divided by the LCCI and the presence of cMvD. Eyes with LCCI ‡11.87 had the fastest RNFL thinning (À2.4 6 0.8 lm/ year, mean 6 SD). Among eyes with LCCI <11.87, the presence of cMvD was the strongest factor influencing faster RNFL thinning (À1.5 6 0.8 lm/year). Eyes with LCCI <11.87 and without a cMvD exhibited the slowest RNFL thinning (À0.8 6 0.9 lm/year). CONCLUSIONS. Our regression tree model demonstrated that larger LCCI, and then the presence of cMvD were the first and second strongest prognostic factors for faster progressive RNFL thinning. Further studies may be needed to confirm these findings.

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“…Open‐angle glaucoma accounts for approximately 80% of all the glaucoma cases seen in the United States . The risk factors for developing visual field defects attributed to open‐angle glaucoma are multifactorial, they include age, larger vertical or horizontal cup‐disc ratio, higher IOP, thinner central corneal thickness, gender, and cardiovascular disease . Although elevated IOP is a risk factor for glaucoma, patients with normal IOP can also present with glaucoma.…”

Section: Discussionmentioning

confidence: 99%

Intranasal Corticosteroids Do Not Lead to Ocular Changes: A Systematic Review and Meta‐analysis

et al. 2018

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Use of INCS is not associated with a significant risk of elevating IOP or developing a posterior subcapsular cataract in patients with allergic rhinitis. Presence of glaucoma, however, is the real clinical adverse event of concern. There were zero reported cases of glaucoma at 12 months. Future studies should formally evaluate for glaucoma rather than use IOP measures as a surrogate. Laryngoscope, 2018.

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Risk Factors for Rapid Glaucoma Disease Progression

Cited by 94 publications

References 61 publications

Evaluating the Impact of Uveitis on Visual Field Progression Using Large-Scale Real-World Data

Evaluating the Impact of Uveitis on Visual Field Progression Using Large-Scale Real-World Data

Elucidation of the Strongest Factors Influencing Rapid Retinal Nerve Fiber Layer Thinning in Glaucoma

Intranasal Corticosteroids Do Not Lead to Ocular Changes: A Systematic Review and Meta‐analysis

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