Risk factors for progression to blindness in high tension primary open angle glaucoma: Comparison of blind and nonblind subjects

Figures & data

Table 1 Risk factors for blindness in glaucoma

IOP
– Elevated IOP (Harbin et al 1976; Kolker 1977; Anderson 1989; O’Brien et al 1991; Araie et al 1994; Quigley et al 1994; Gherghel et al 2000; King et al 2000; Stewart et al 2000; The AGIS Investigators 2000; Kwan et al 2001).
– Large diurnal variations (The AGIS Investigators 2000; Oliver et al 2002).
– Poor control of IOP (Oliver et al 2002).
– Mean IOP in the better eye (King et al 2000).
Older age (Quigley et al 1994; Hattenhauer et al 1998; Stewart et al 2000).
Advanced VF damage at diagnosis (Harrington 1959; Kolker 1977; Grant and Burke 1982; Leski 1983; Quigley et al 1994; Oliver et al 2002; Chen 2003).
Black American (Hiler and Kahn 1975; Sommer et al 1991a, 1991b).
Longer duration of disease (Grant and Burke 1982).
Noncompliance (Spaeth 1971; Grant and Burke 1982; Chen 2003).
Frequent disc hemorrhage (Drance et al 1981).
Late detection (Spaeth 1971; Perkins 1978; Grant and Burke 1982; Fraser et al 1999).
Worse vision (Grant and Burke 1982).
Vascular insufficiency (Reese and McGavic 1942; Spaeth 1971; Drance et al 1978; Grant and Burke 1982; Gherghel et al 2000).
Family history of glaucoma (Drance et al 1978).
Greater number of antiglaucoma medications (Kwan et al 2001).
Glaucoma surgery (Kwan et al 2001).
Higher socioeconomic class (King et al 2000).
VF loss in the worse eye (King et al 2000).

Abbreviations: IOP, intraocular pressure; VF, visual field.

Table 2 Demographics and characteristics of composite patient population: No blindness versus blindness

Characteristics	No blindness n (%) 282	Blindness n (%) 205	p value
Age at diagnosis, yr (mean ± SD, median, range)	59.0 ± 12.6, 59.4, 21.2–86.9	59.3 ± 13.2, 61.1, 28.8–90.4	0.52
Follow-up, yr (mean ± SD, median, range)	5.1 ± 3.1, 4.2, 1.0–18.1	6.1 ± 4.0, 5.2, 0.3–23.7	0.04
Male	151 (53.5)	139 (67.8)	p < 0.002
Female	131 (46.4)	66 (32.2)
Caucasian	124 (44.0)	69 (33.7)
Black American	134 (47.4)	119 (58.1)
Hispanic	12 (4.3)	7 (3.4)
Other ethnicities	12 (4.3)	10 (4.8)
Ocular surgeries
Cataract	52 (18.4)	48 (23.4)	0.211
ALT	92 (32.6)	89 (43.4)	0.020
LPI	29 (10.3)	31 (15.2)	0.124
Trabeculectomy	28 (9.9)	60 (29.3)	<0.0001
Combined	22 (7.8)	18 (8.8)	0.740
Cyclodestruction	0 (0.0)	9 (4.4)	<0.0004
Others	14 (5.0)	16 (7.8)	0.252
Visual acuity Deterioration	36 (12.7)	82 (40.0)	<0.0001
VF progression	46 (16.3)	47 (22.9)	0.10
IOP mmHg (mean ± SD, median, range)
Initial visit	22.1 ± 7.7, 21.0, 2–70	24.2 ± 11.2, 21.0, 2.0–70.0	0.030
Final visit	18.1 ± 2.4, 18.0, 10.0–26.0	17.7 ± 4.8, 18.0, 0.0–46.0	0.153
C/D ratio progression	92 (32.6)	55 (26.8)	0.20
Noncompliance	131 (46.4)	129 (63.0)	<0.0003
Poor control	207 (73.4)	196 (95.6)	<0.0001
Late detection	248 (87.9)	195 (95.1)	0.006

Notes: Blindness was defined as visual acuity of 20/200 or worse and/or visual field less than 20° in either eye.

Abbreviations: ALT, argon laser trabeculoplasty; LPI, laser peripheral iridotomy; CF, count fingers; HM, hand motion; LP, light perception; NLP, no light perception; VF, visual field; IOP, intraocular pressure; C/D, cup-to-disc; CAI, carbonic anhydrase inhibitor.

Figure 1 Prevalence of blindness in relation to intraocular pressure. Blindness was prevalent at all levels of intraocular pressure. 26.3 % of patients were blind at pressures of 17 mmHg or less.

Table 3 Multiple logistic regression analysis of the various variables and their effect on progression to blindness

Parameter	Odds ratio	95% confidence limit for odds ratio	p value
Age at diagnosis	1.008	0.993–1.024	0.281
Race	1.148	0.919–1.435	0.224
Baseline IOP (>22 mmHg vs. <22 mmHg)	1.54	1.05–2.268	0.028
Clinic	1.157	0.905–1.478	0.244
Gender (female vs. male)	0.601	0.383–0.943	0.0268
Baseline VF (1 scotoma or worse vs. normal)	13.698	4.863–38.582	<0.00001

Abbreviations: IOP, intraocular pressure; VF, visual field.

HarbinTSPodosSMKolkerAE1976Visual field progression in open-angle glaucoma patients presenting with monocular field lossTrans Am Acad Ophthalmol Otol812537

 Google Scholar

KolkerAE1977Visual prognosis in advanced glaucoma: A comparison of medical and surgical therapy for retention of vision in 101 eyes with advanced glaucomaTrans Am Ophth SocLXXV53955

 Google Scholar

AndersonDR1989Glaucoma: The damage caused by pressure. XLVI Edward Jackson Memorial LectureAm J Ophthalmol108485952683792

 PubMed Web of Science ®Google Scholar

O’BrienCSchwartzBTakamotoT1991Intraocular pressure and the rate of visual field loss in chronic open angle glaucomaAm J Ophthalmol1114915002012152

 PubMed Web of Science ®Google Scholar

AraieMSekineMSuzukiY1994Factors contributing to the progression of visual field damage in eyes with normal-tension glaucomaOphthalmology101144048058289

 PubMed Web of Science ®Google Scholar

QuigleyHAEngerCKatzJ1994Risk factors for the development of glaucomatous visual field loss in ocular hypertensionArch Ophthalmol11264498185522

 PubMed Web of Science ®Google Scholar

GherghelDOrgülSGugletaK2000Relationship between ocular perfusion pressure and retrobulbar blood flow in patients with glaucoma with progressive damageAm J Ophthalmol13059760511078838

 PubMed Web of Science ®Google Scholar

KingAJWThompsonJRRosenthalAR2000Factors influencing the progression to blindness in patients with primary open angle glaucomaInvest Ophthalmol Vis Sci41SupplS477

 Google Scholar

StewartWCKolkerAESharpeED2000Factors associated with long-term progression or stability in primary open-angle glaucomaAm J Ophthalmol130274911020404

 PubMed Web of Science ®Google Scholar

The AGIS Investigators2000The Advanced Glaucoma Intervention Study (AGIS): 7 The relationship between control of intraocular pressure and visual field deteriorationAm J Ophthalmol1304294011024415

 PubMed Web of Science ®Google Scholar

KwanUHKimCSZimmermanB2001Rate of visual field loss and long-term visual outcome in primary open angle glaucomaAm J Ophthalmol132475611438053

 PubMed Web of Science ®Google Scholar

OliverJEHattenhauerMGHermanD2002Blindness and Glaucoma: a comparison of patients progressing to blindness from glaucoma with patients maintaining visionAm J Ophthalmol1337647212036667

 PubMed Web of Science ®Google Scholar

HattenhauerMGJohnsonDHIngHH1998The probability of blindness from open-angle glaucomaOphthalmology105200914

 Web of Science ®Google Scholar

HarringtonDO1959The pathogenesis of the glaucoma field. Clinical evidence that circulatory insufficiency in the optic nerve is the primary cause of visual field loss in glaucomaAm J Ophthalmol471778513649857

 PubMed Web of Science ®Google Scholar

GrantMBurkeJFJr1982Why do some people go blind from glaucoma?Ophthalmology8999187177577

 PubMed Web of Science ®Google Scholar

LeskeMC1983The epidemiology of open-angle glaucoma: a reviewAm J Epidemiol118166916349332

 PubMed Web of Science ®Google Scholar

ChenPP2003Blindness in patients with treated open angle glaucomaOphthalmology11072133

 Web of Science ®Google Scholar

HillerRKahnHA1975Blindness from glaucomaAm J Ophthalmol806291155551

 PubMed Web of Science ®Google Scholar

SommerATielschJKatzJ1991aRacial differences in the cause-specific prevalence of blindness in East BaltimoreN Engl J Med3251412171922252

 PubMed Web of Science ®Google Scholar

SommerATielschJMKatzJ1991bRelationship between intraocular pressure and primary open angle glaucoma among white and black Americans: the Baltimore Eye SurveyArch Ophthalmol109109051867550

 PubMed Web of Science ®Google Scholar

SpaethGL1971Pathogenesis of visual loss in patients with glaucoma. Pathologic and sociologic considerationsTrans Am Acad Ophthalmol Otol75296317

 Google Scholar

DranceSMSchulzerMThomasB1981Multivariate analysis in glaucoma. Use of discriminant analysis in predicting glaucomatous visual field damageArch Ophthalmol991019227236098

 PubMedGoogle Scholar

PerkinsES1978Blindness from glaucoma and the economics of preventionTrans Ophthalmol Soc UK982935286459

 PubMedGoogle Scholar

FraserSBunceCWormaldR1999Retrospective analysis of risk factors for late presentation of chronic glaucomaBr J Ophthalmol8324810209429

 PubMed Web of Science ®Google Scholar

ReeseABMcGavicJS1942Relation of field contraction to blood pressure in chronic primary glaucomaArch Ophthalmol2784550

 Google Scholar

DranceSMSchulzerMDouglasGR1978Use of discriminate analysis. II. Identification of persons with glaucomatous visual field defectsArch Ophthalmol9615713687196

 PubMedGoogle Scholar