The probability of blindness from open-angle glaucoma

doi:10.1016/S0161-6420(98)91133-2

Ophthalmology

Volume 105, Issue 11, 1 November 1998, Pages 2099-2104

Presented at the Association for Research in Vision and Ophthalmology annual meeting, Fort Lauderdale, Florida, May 1997.

https://doi.org/10.1016/S0161-6420(98)91133-2 Get rights and content

Abstract

Objective

This study aimed to determine the probability of a patient developing legal blindness in either one or both eyes from newly diagnosed and treated open-angle glaucoma (OAG) after starting medical or surgical therapy or both.

Design

The study design was a retrospective, community-based descriptive study.

Participants

Two hundred ninety-five residents of Olmsted County, Minnesota, newly diagnosed with, and treated for, OAG between 1965 and 1980 with a mean follow-up of 15 years (standard deviation ± 8 years) participated.

Intervention

Kaplan-Meier cumulative probability of blindness was estimated for patients treated and followed for OAG.

Main outcome measures

Legal blindness, defined as a corrected visual acuity of 20/200 or worse, and/or visual field constricted to 20° or less in its widest diameter with the Goldmann III4e test object or its equivalent on automated perimetry, secondary to glaucomatous loss, was measured.

Results

At 20-years’ follow-up, the Kaplan-Meier cumulative probability of glaucoma-related blindness in at least one eye was estimated to be 27% (95% confidence interval, 20%–33%), and for both eyes, it was estimated to be 9% (95% confidence interval, 5%–14%). At the time of diagnosis, 15 patients were blind in at least 1 eye from OAG.

Conclusion

A retrospective study of a white population determined that the risk of blindness from newly diagnosed and treated OAG may be considerable.

Section snippets

Subjects and methods

This study is a retrospective, community-based, longitudinal study of residents of Olmsted County, Minnesota, who were newly diagnosed with OAG between 1965 and 1980. This period was chosen to allow for adequate follow-up after diagnosis.

Study patients were identified through a computerized search of the database of the Rochester Epidemiology Project (REP), a medical records linkage system established to study the occurrence and natural history of disease among the residents of Rochester and

Results

Two hundred ninety-five patients were identified as newly diagnosed OAG over the 15-year period. Two hundred sixty-five (90%) of 295 were diagnosed with POAG, 25 (8%) of 295 with exfoliative glaucoma, and 5 (2%) of 295 with pigmentary glaucoma. Based on the classification described above, a total of 114 patients (60%) were identified as having classic glaucoma, 177 patients (39%) were classified as having treated ocular hypertension, and 4 patients (1%) were classified as having unsupported

Discussion

Our study indicates that OAG leads to blindness in a significant number of individuals, even while patients are receiving therapy. Kaplan-Meier life-table analysis estimates a probability of 9% for bilateral blindness and a 27% probability of blindness in at least one eye from classic glaucoma and treated ocular hypertension at 20 years. The development of blindness was more common in patients with classic glaucoma, with a 22% probability in both eyes and a 54% probability in at least one eye

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In the last years, neuroprotective therapies have attracted the researcher interests as modern and challenging approach for the treatment of neurodegenerative diseases, aimed at protecting the nervous system from injuries. Glaucoma is a neurodegenerative disease characterized by progressive excavation of the optic nerve head, retinal axonal injury and corresponding vision loss that affects millions of people on a global scale. The molecular basis of the pathology is largely uncharacterized yet, and the therapeutic approaches available do not change the natural course of the disease. Therefore, in accordance with the therapeutic regimens proposed for other neurodegenerative diseases, a modern strategy to treat glaucoma includes prescription of drugs with neuroprotective activities. With respect to this, several preclinical and clinical investigations on a plethora of different drugs are currently ongoing. In this review, first, the conceptualization of the rationale for the adoption of neuroprotective strategies for retina is summarized. Second, the molecular aspects highlighting glaucoma as a neurodegenerative disease are reported. In conclusion, the molecular and pharmacological properties of most promising direct neuroprotective drugs used to delay glaucoma progression are examined, including: neurotrophic factors, NMDA receptor antagonists, the α2-adrenergic agonist, brimonidine, calcium channel blockers, antioxidant agents, nicotinamide and statins.
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All participants underwent clinical examination of the optic disc and RNFL, OCT RNFL imaging, and 24-2 standard automated perimetry. To detect RNFL defects, ROTA was applied. The risk score for glaucoma development was calculated according to the Ocular Hypertension Treatment Study and European Glaucoma Prevention Study (OHTS-EGPS) risk prediction model. Risk factors associated with RNFL defects were analyzed using multilevel logistic regression analysis.
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The average intraocular pressure (IOP) measured from 3 separate visits within 6 months was 24.9 ± 1.8 mmHg for the eye with higher IOP and 23.7 ± 1.7 mmHg for the eye with lower IOP; the respective central corneal thicknesses were 568.7 ± 30.8 μm and 568.8 ± 31.2 μm. Of 306 patients with OHT, 10.8% (33 patients, 37 eyes) demonstrated RNFL defects in ROTA in at least 1 eye. Of the 37 eyes with RNFL defects, the superior arcuate bundle was the most frequently involved (62.2%), followed by the superior papillomacular bundle (27.0%) and the inferior papillomacular bundle (21.6%). Papillofoveal bundle defects were observed in 10.8% of eyes. The smallest RNFL defect spanned 0.0° along Bruch’s membrane opening margin, whereas the widest RNFL defect extended over 29.3°. Age (years) (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.03–1.13), VF pattern standard deviation (decibels [dB]) (OR, 1.82; 95% CI, 1.01–3.29), cup volume (mm³) (OR, 1.24; 95% CI, 1.01–1.53), and the OHTS-EPGS risk score (OR, 1.04; 95% CI, 1.01–1.07) were associated with RNFL defects.
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Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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^☆: Supported in part by Research to Prevent Blindness, Inc, New York, New York; the Mayo Foundation, Rochester, Minnesota; and grant number 30582, the National Institutes of Health, Bethesda, Maryland.

View full text

The probability of blindness from open-angle glaucoma☆

Abstract

Objective

Design

Participants

Intervention

Main outcome measures

Results

Conclusion

Section snippets

Subjects and methods

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Mayo Clin Proc

Ophthalmology

Number of people with glaucoma worldwide

Br J Ophthalmol

Rational choice of therapy in primary open angle glaucoma

Eye

The benefit of early trabeculectomy versus conventional management in primary open angle glaucoma relative to severity of disease

Eye