Risk factors for structural and functional progression of primary open-angle glaucoma in an African ancestry cohort

Abstract

Background/aimsTo investigate the rates of structural and functional progression of primary open-angle glaucoma in an African ancestry cohort and identify risk factors for progression.MethodsThis retrospective study included 1424 eyes from glaucoma cases in the Primary Open-Angle African American Glaucoma Genetics cohort, with ≥2 visits for retinal nerve fibre layer (RNFL) thickness and mean deviation (MD) measurements over ≥6-month follow-up. The rates of structural progression (change in RNFL thickness/year) and functional progression (change in MD/year) were calculated from linear mixed effects models, accounting for intereye correlation and longitudinal correlation. Eyes were categorised as slow, moderate or fast progressors. Risk factors for progression rates were assessed using univariable and multivariable regression models.ResultsThe median (interquartile) rates of progression were −1.60 (−2.05 to –1.15) µm/year for RNFL thickness and −0.40 (−0.44 to –0.34) decibels/year for MD. Eyes were categorised as slow (structural: 19%, functional: 88%), moderate (structural: 54%, functional: 11%) and fast (structural: 27%, functional: 1%) progressors. In multivariable analysis, faster RNFL progression was independently associated with thicker baseline RNFL (p<0.0001), lower baseline MD (p=0.003) and beta peripapillary atrophy (p=0.03). Faster MD progression was independently associated with higher baseline MD (p<0.0001), larger cup-to-disc ratios (p=0.02) and lower body mass index (p=0.0004).ConclusionThe median rates of structural and functional progression in this African ancestry cohort were faster than the rates reported from previously published studies in other ethnic groups. Higher baseline RNFL thickness and MD values were associated with faster progression rates. Results highlight the importance of monitoring structural and functional glaucoma progression to provide timely treatment in early disease.

Paving the way while playing catch up: mitochondrial genetics in African ancestry primary open-angle glaucoma

“…Glaucoma in the African descent population is also associated with more severe phenotypes with poorer outcomes ( 6 , 7 ). Damage to the disc, retina, and visual field both at initial diagnosis and progression with disease were more significant in individuals of African descent ( 55 , 56 , 58 ). With the same elevated mean IOP levels and similar access to care, African Americans were also more likely to present with more severe visual field defects than European Americans ( 6 ).…”

“…Individuals of African descent face a disproportionately higher risk of POAG onset, progression, severity, and health-related quality of life burden ( 6 – 8 , 53 – 56 , 58 ). Yet, this same population is often underrepresented in research studies aimed at understanding and addressing this disease and related health conditions.…”