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Abstract #60169 Published in IGR 16-4
Threat to Fixation at Diagnosis and Lifetime Risk of Visual Impairment in Open-Angle Glaucoma
Peters D; Bengtsson B; Heijl AOphthalmology 2015; 122: 1034-1039
PURPOSE: To investigate whether threat to fixation (TTF) at diagnosis increases the risk of central vision loss and glaucoma blindness. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 309 patients (309 eyes) with glaucoma were followed up until death; 203 patients (65.7%) had primary open-angle glaucoma, and 106 patients (34.2%) had exfoliation glaucoma. METHODS: Study eyes were divided into 2 groups according to TTF in the first glaucomatous visual field: (1) eyes with TTF, defined as visual field loss (VFL) including ≥1 of the 4 innermost points depressed at P < 1% level in 24-2 or 30-2 Humphrey fields; (2) eyes without TTF, defined as VFL only outside the 4 innermost points. Lifetime risk of visual acuity (VA) loss and glaucoma blindness in the 2 groups was compared by logistic regression analysis. A matching technique was used to adjust for differences in disease stage at presentation. The relative influence of TTF on the risk of blindness in the 2 matched groups was analyzed by the Kaplan-Meier method. MAIN OUTCOME MEASURES: Visual acuity <0.3 and blindness from glaucoma (World Health Organization criteria) at last visit. RESULTS: Threat to fixation was detected in 58.9% of the eyes at diagnosis. The frequency of TTF increased with stage of glaucomatous loss: 28.3% in eyes with mean deviation (MD) >-6.00 decibels (dB) versus 95.7% with MD <-20.00 dB. Univariate analysis demonstrated that eyes with TTF at presentation compared with eyes without TTF became blind more often (56/182 [30.8%] vs. 22/127 [17.3%]; P = 0.008) and faster (mean time from diagnosis to blindness, 84.6±50.7 vs. 126.7±51.4 months; P < 0.002). However, in multivariate analysis, TTF was not an independent risk factor for VA <0.3 (odds ratio, 1.43; 95% confidence interval, 0.75-2.74) or blindness (odds ratio, 1.03; 95% confidence interval, 0.52-2.01). With regard to patient survival time, there were no differences between eyes with TTF and eyes without TTF after adjusting for disparities in disease severity at presentation (P = 0.934). CONCLUSIONS: Including TTF in the assessment of risk for glaucoma blindness did not add any important information when the stage of VFL was taken into account.
Department of Ophthalmology, Lund University, Skåne University Hospital, Malmö, Sweden. Electronic address: dorothea.peters@med.lu.se.
Full articleClassification:
1.5 Glaucomas as cause of blindness (Part of: 1 General aspects)
