Glaucoma blindness at the end of life

Mokhles, Palwasha; Schouten, Jan S.A.G.; Beckers, Henny J. M.; Azuara‐Blanco, Augusto; Tuulonen, A; Webers, Carroll A.B.

doi:10.1111/aos.12933

Cited by 15 publications

(13 citation statements)

References 12 publications

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“…A considerable number of patients with glaucoma, glaucoma suspect, or ocular hypertension will die blind or with [15][16][17][18][19][20][21]. Differences in operational definition (whether or not including the VF in the definition, which is mostly not counted for in the several definitions that currently exists), the time period in which patients died and regional differences in the prevalence of eye diseases and treatment could explain the differences in prevalence of blindness between these studies.…”

Section: Discussionmentioning

confidence: 99%

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Contributing ocular comorbidity to end-of-life visual acuity in medically treated glaucoma patients, ocular hypertension and glaucoma suspect patients

Mokhles

Gorcom

Schouten

et al. 2020

Eye

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Aim To assess the visual acuity at the end of life in glaucoma suspect patients, ocular hypertension, and patients treated for glaucoma and to find factors contributing to a reduced visual acuity in this cohort of deceased patients. Methods In a cohort of 3883 medically treated glaucoma patients, glaucoma suspect, or patients with ocular hypertension assembled in 2001-2004, 1639 were deceased. Patient data were collected from electronic and paper patient files. The files of 1378 patients were studied and the last measured visual acuity and ocular comorbidities influencing the visual acuity were extracted. Results Our results show that only 37.2% of patients had no visual impairment in either eye, 30.5% was visually impaired or blind in both eyes and 4.1% was blind in both eyes, all based on VA. The most common contributing factors for severe visual impairment or blindness (prevalence ≥ 1%) were: glaucoma, retinal vein occlusion, dry and exudative age-related macular degeneration, past retinal detachment, amblyopia, diabetic retinopathy, anterior ischemic optic neuropathy, trauma, decompensated cornea, past keratitis, enucleation, corneal transplantation, and macular hole. Conclusions Despite the current advanced treatment modalities for glaucoma, 30.5% of patients had a VA < 0.5 in both eyes and 4.1% was blind in both eyes. However, this disability cannot be confidently attributed only to glaucoma. Besides glaucoma, most common contributing factors were among others retinal and macular diseases. Patient management in glaucoma should be based on more than lowering the intraocular pressure to prevent blindness at the end of life.

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Section: Discussionmentioning

confidence: 99%

“…The observation that glaucoma is a relevant contributing factor could be either due to an advanced stage of glaucoma at diagnosis or a progressive course, or both [18,27]. Patient delays and delays in the health care system may contribute to a late diagnosis [28].…”

Section: Discussionmentioning

confidence: 99%

Contributing ocular comorbidity to end-of-life visual acuity in medically treated glaucoma patients, ocular hypertension and glaucoma suspect patients

Mokhles

Gorcom

Schouten

et al. 2020

Eye

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“…Glaucoma is characterized by progressive optic nerve degeneration and visual field loss. Ten percent of glaucoma patients will become blind in both eyes or encounter severe visual field loss in both eyes at one point in their life [ 1 ]. There is no causative treatment; thus, treatment is aimed at lowering intraocular pressure (IOP) to a target level to prohibit further damage [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and cost-effectiveness of MicroShunt implantation versus standard trabeculectomy for open-angle glaucoma (a SIGHT study): study protocol of a multicentre randomised controlled trial

et al. 2023

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Background Trabeculectomy is the “gold standard” initial surgical procedure for open-angle glaucoma worldwide. During the last decade, the introduction of less invasive procedures, including new bleb-forming surgery such as the MicroShunt, has altered the approach of glaucoma management. At present, there is insufficient evidence comparing the effectiveness between these procedures nor versus trabeculectomy. Furthermore, there is no data available on patient impact and cost-effectiveness. This study aims to address this gap in evidence and establish whether MicroShunt implantation is non-inferior compared to trabeculectomy with regard to effectiveness and whether it is cost-effective. Methods A multicentre, non-inferiority, randomised controlled trial (RCT) studying open-angle glaucoma with an indication for surgery will be conducted. Patients with previous ocular surgery except for phacoemulsification are excluded, as are patients with ocular comorbidity compromising the visual field or requiring a combined procedure. After informed consent is obtained, patients will be randomly allocated to the intervention, a PRESERFLO™ MicroShunt implantation, or the control group, trabeculectomy, using block randomisation (blocks of 2, 4 or 6 patients). In total, 124 patients will be randomised in a 1:1 ratio, stratified by centre. The primary endpoint will be intraocular pressure (IOP) one year after surgery. Secondary outcomes include IOP-lowering medication use, treatment failure, visual acuity, visual field progression, additional interventions, adverse events, patient-reported outcome measures (PROMs), and cost-effectiveness. Study outcomes will be measured up to 12 months postoperatively. Discussion This study protocol describes the design of a multicentre non-inferiority randomised controlled trial. To this date, cost-effectiveness studies evaluating the MicroShunt have not been undertaken. This multicentre RCT will provide more insight into whether MicroShunt implantation is non-inferior compared to standard trabeculectomy regarding postoperative IOP and whether MicroShunt implantation is cost-effective. Trial registration ClinicalTrials.gov, Identifier: NCT03931564, Registered 30 April 2019.

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“…This causes a gradual narrowing of the visual field and eventually blindness can occur [ 1 , 2 ]. Globally, glaucoma is the second leading cause of blindness and the first cause of irreversible (permanent) blindness [ 3 , 4 , 5 ]. There are several types of glaucoma: POAG (primary open-angle glaucoma with high intra-ocular pressure) is the most common form of glaucoma, which is responsible for over 90% of cases; NTG (normal tension glaucoma -primary open-angle glaucoma with normal intra-ocular pressure, particular form of open-angle glaucoma); PACG (primary closed-angle glaucoma); congenital glaucoma; and glaucoma secondary to other conditions (local trauma, adverse effects following treatments, etc.).…”

Section: Introductionmentioning

confidence: 99%

Aspects of Tertiary Prevention in Patients with Primary Open Angle Glaucoma

Munteanu

Roiu

et al. 2021

JPM

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The purpose of the study is to assess the health of patients in the activity of tertiary prevention dedicated to preventing blindness caused by POAG (primary glaucoma with open angle and high tension) and NTG (primary glaucoma with open-angle and statistically normal tension—particular form of glaucoma with open angle) and preservation of the remaining visual function. The design of the study is epidemiological, observational, descriptive and retrospective, and uses only the data recorded in the existing records in the archives of the Ophthalmology office within the Integrated Outpatient Clinic of the Emergency Clinical Hospital of Oradea (IOCECHO) during the years 1999–2019 (anamnestic data; objective examination and paraclinical examination: intraocular pressure—IOP and visual field—VF). The methods of the study included the standardized protocol: anamnesis, physical ophthalmological examination, IOP determination, and computerized perimetry with the “Fast Threshold” strategy performed with the “Opto AP-300” perimeter. The obtained results were statistically processed with a specialized software (S.P.S.S.—I.B.M. Statistics version 22). The study examined the available data of 522 patients of which 140 were men (26.8%) and 382 were women (73.2%). The gender ratio was 0.37. In the period 1999–2019, 150,844 people with ophthalmic pathology were consulted in the Ophthalmology office of IOCECHO out of which 522 patients (0.35%) were diagnosed with primitive open-angle glaucoma, 184 people (35.2%) presented high IOP (POAG), and 338 people (64.8%) had statistically normal IOP (NTG). The annual proportion of cases diagnosed with glaucoma in the total number of patients examined was between 0.1% (2005; 2008; 2010) and 2.4% in 2012, when 101 people were detected. In the studied records, no cases of uni- and/or bilateral blindness were mentioned. The mean age of glaucoma patients at the first consultation was 60.81 ± 12.14 years with high frequencies in the 55–69 age groups and at the last consultation it was 66.10 ± 12.47 years with high frequencies in the age groups between 60–74 years. Monitoring and treatment of glaucoma patients was beneficial; IOP decreased statistically significantly: in patients with POAG by 46.16%, from 30.50 ± 7.98 mmHg to 16.42 ± 3.01 mmHg (p = 0.000) and in those with NTG by 17.44%, at 16.39 ± 3.66 mmHg at 13.53 ± 1.92 mmHG (p = 0.000). The duration of treatment and monitoring was on average 5.1 ± 3.4 years, for 184 patients (35.2%) with POAG and 5.1 ± 3.8 years for 338 patients (64.8%) with NTG. Tertiary prevention of glaucoma, by providing specialized care, ensures effective control of IOP and implicitly of the long-term evolution of the disease. IOP is the only modifiable risk factor in patients with POAG and NTG and its decrease prevents the progression of the disease and emphasizes the importance of early diagnosis and treatment. The management of the glaucoma patient consisted of: complete ophthalmological examination (subjective and objective), paraclinical examination with IOP, and VF measurement (valuable ophthalmological diagnostic tool) for disease detection and effective assessment of disease progression in order to improve the process of therapeutic decision making.

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Glaucoma blindness at the end of life

Cited by 15 publications

References 12 publications

Contributing ocular comorbidity to end-of-life visual acuity in medically treated glaucoma patients, ocular hypertension and glaucoma suspect patients

Contributing ocular comorbidity to end-of-life visual acuity in medically treated glaucoma patients, ocular hypertension and glaucoma suspect patients

Effectiveness and cost-effectiveness of MicroShunt implantation versus standard trabeculectomy for open-angle glaucoma (a SIGHT study): study protocol of a multicentre randomised controlled trial

Aspects of Tertiary Prevention in Patients with Primary Open Angle Glaucoma

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