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Abstract #81369 Published in IGR 20-3
Evaluating the Impact of Uveitis on Visual Field Progression Using Large Scale Real-World Data
Liu X; Kelly SR; Montesano G; Bryan SR; Barry RJ; Keane PA; Denniston AK; Crabb DPAmerican Journal of Ophthalmology 2019; 207: 144-150
PURPOSE: To compare rates of visual field (VF) loss in uveitis patients with glaucoma against patients with primary open angle glaucoma (POAG) and explores the association between intraocular pressures (IOP) and rate of VF loss. DESIGN: ; Retrospective cohort study. METHODS: Anonymized VFs and IOP measurements extracted from the EMR of 5 regionally different glaucoma clinics in England. A total of 205 eyes with diagnosis of "uveitis" plus "glaucoma" were compared with 4600 eyes with "POAG" only. Minimum inclusion criteria was ≥4 visits within a 4-year window. Relative risk (RR) of being a "rapid progressor" (mean deviation (MD) loss ≥1.5 dB/year) was calculated. A mixed-effects model (MEM) and a pointwise VF progression analysis of pattern deviation was used to confirm differences between the groups. Longitudinal IOP mean, range and variability were compared with rate of VF progression. RESULTS: Median (IQR) baseline MD in the uveitis and POAG groups was -3.8 (-8.7, -1.5) dB and -3.1 (-6.6, -1.2) dB respectively. The uveitis and POAG groups had 23/205 (11%) and 331/4600 (7%) "rapidly progressing" eyes respectively. Age-adjusted RR for "rapid progression" in uveitic versus POAG eyes was 1.9 (95% CI:1.8-2.0). The MEM confirmed that uveitic eyes (-0.49 dB/year) showed higher rates of VF progression than the POAG group (-0.37 dB/year; p<0.01). IOP range and variability were higher in the "rapidly progressing" uveitic eyes. CONCLUSIONS: Our analysis suggests that VF loss occurs faster in glaucoma patients with uveitis than those without uveitis. The risk of progressing rapidly in glaucoma with uveitis is almost double than in those without uveitis. Early identification of "rapid progressors" may enable targeted intervention to preserve visual function in this high-risk group.
Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, University of Birmingham, UK; NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, UK.
Full articleClassification:
9.4.6 Glaucomas associated with inflammation, uveitis (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
6.20 Progression (Part of: 6 Clinical examination methods)
