The African Descent and Glaucoma Evaluation Study (ADAGES): Predictors of Visual Field Damage in Glaucoma Suspects

Abstract

Purpose To evaluate racial differences in the development of visual field (VF) damage in glaucoma suspects. Design Prospective, observational cohort study. Methods Six hundred thirty six eyes from 357 glaucoma suspects with normal VF at baseline were included from the multicenter African Descent and Glaucoma Evaluation Study (ADAGES). Racial differences in the development of VF damage were examined using multivariable Cox Proportional Hazard models. Results Thirty one (25.4%) of 122 African descent participants and 47 (20.0%) of 235 European descent participants developed VF damage (p=0.078). In multivariable analysis, worse baseline VF mean deviation, higher mean arterial pressure during follow up, and a race *mean intraocular pressure (IOP) interaction term were significantly associated with the development of VF damage suggesting that racial differences in the risk of VF damage varied by IOP. At higher mean IOP levels, race was predictive of the development of VF damage even after adjusting for potentially confounding factors. At mean IOPs during follow-up of 22, 24 and 26 mmHg, multivariable hazard ratios (95%CI) for the development of VF damage in African descent compared to European descent subjects were 2.03 (1.15–3.57), 2.71 (1.39–5.29), and 3.61 (1.61–8.08), respectively. However, at lower mean IOP levels (below 22 mmHg) during follow-up, African descent was not predictive of the development of VF damage. Conclusion In this cohort of glaucoma suspects with similar access to treatment, multivariate analysis revealed that at higher mean IOP during follow-up, individuals of African descent were more likely to develop VF damage than individuals of European descent.

Rate and Pattern of Rim Area Loss in Healthy and Progressing Glaucoma Eyes

“…Among those who did not develop POAG the rate of rim area loss was very similar in African American and other participants (−2.4 ×10 −3 mm 2 /year and −2.6 ×10 −3 mm 2 /year, respectively). 41 In another recent ADAGES report 42 AD suspect eyes that developed visual field loss (average follow-up 7.5±2.0 years), had a significantly faster rate of rim area loss than ED eyes. Racial differences were not as pronounced in the current study, perhaps because both AD and ED eyes in the progressing glaucoma group had documented photography-based optic disc damage at baseline and agreement in the rate of HRT change and photograph-based progression are limited.…”

“…In the multivariate models, appropriate 2-way interactions (e.g., covariate x time) were studied to evaluate change over time. Based on past ADAGES results in glaucoma suspects, 42 an interaction term was included to account for the possibility of a non-linear relationship between IOP and rate of rim area change (IOP x IOP). To evaluate the possibility that racial differences in the rate of rim area loss varied by disease status, a 3-way interaction term (race x group x time) was also included in the multivariable model.…”

Primary Open-Angle Glaucoma Genetics in African Americans

“…IOP is modified by various lifestyle activities (17) but, further complicating the association of IOP with POAG, IOP has not been show to increase with age (reviewed in (3)). Interestingly, African Americans are more likely to experience visual field damage at higher IOP levels (20) suggesting a greater IOP “sensitivity”.…”

“…Disturbingly, POAG is more likely to result in vision loss and blindness in African Americans compared to other populations in the U.S.; African Americans typically suffer from higher mean IOP levels and not unsurprisingly, African American race has been found to predict visual field damage (20). Further, ocular anatomy may differ across ethnic groups - height of trabecular meshwork in African Americans is shorter, on average, when compared with Asians and Caucasians (24).…”

A Longitudinal Study of Association between Adiposity Markers and Intraocular Pressure: The Kangbuk Samsung Health Study

“…Intraocular pressure (IOP) is a key risk factor in the development and progression of primary open-angle glaucoma[ 1 – 3 ], and is associated with demographic factors including age, sex, race, as well as ocular and systemic factors such as central corneal thickness, refractive error, and anterior chamber anatomy. [ 4 – 6 ] IOP reduction or stabilization is the only proven method for glaucoma management, which may slow progression even for normal-tension glaucoma.…”