Incorporating life expectancy in glaucoma care

Wesselink, Christiaan; Stoutenbeek, Remco; Jansonius, Nomdo M.

doi:10.1038/eye.2011.213

Cited by 23 publications

(28 citation statements)

References 28 publications

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“…This is revealing because it underlines the reduced risk of visual disability in those patients who are diagnosed in the earlier stages of the disease, not only because they have greater preserved vision to start with but they are, according to our data, less likely to progress rapidly than those patients who are diagnosed at a later stage. [27][28][29] It is worth noting that the magnitude of this effect is, however, quite small. Moreover, precision of estimates of MD rates in individual eyes varies with VF damage and this has been established elsewhere.…”

Section: Discussionmentioning

confidence: 88%

Are rates of vision loss in patients in English glaucoma clinics slowing down over time? Trends from a decade of data

Boodhna

Saunders

Crabb

2015

Eye

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Purpose To examine changes in rates of visual field (VF) progression in patients attending a sample of glaucoma clinics in England between 1999 and 2012. Methods An archive of 473 252 Humphrey VFs recorded across the UK was retrospectively examined. Distribution of rates recorded in the first half of the decade was compared with the second. The relationship between age and severity of MD loss at baseline with rates of loss and frequency of testing was examined. Results VF series from 18 926 eyes were analysed. Median rate of MD loss for the period before and after 2003 was − 0.11 and − 0.06 dB/year, respectively, but the proportion of eyes with medium or fast rates of MD loss remained constant. Median rate of MD loss in older (470 years) eyes was faster than that observed in younger (o60 years) eyes (−0.21 compared with − 0.01 dB/ year). Median rate of loss did not vary with severity of MD loss at baseline. Frequency of testing, typically carried out annually, did not vary by age, rate of loss or disease severity. Conclusions VFs of eyes treated in the first half of the decade deteriorated more rapidly than those in the second half. Several factors might explain these differences but average effects were small and there was no reduction in the proportion of rapidly progressing eyes over the decade. Older age and, to a lesser extent, worse VF damage at diagnosis are indicators for faster VF loss in clinics, but frequency of VF testing was similar for all patients.

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Section: Discussionmentioning

confidence: 88%

Are rates of vision loss in patients in English glaucoma clinics slowing down over time? Trends from a decade of data

Boodhna

Saunders

Crabb

2015

Eye

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“…Risk of visual impairment depends on the stage of disease at presentation, the life expectancy as well as the rate of visual deterioration 13 14. Clearly, patients with rapid VF progression are at greater risk of suffering blindness than patients with slow progression; hence, one method to identify those patients who require the most attention is to calculate their rates of VF loss over time.…”

Section: Discussionmentioning

confidence: 99%

Are practical recommendations practiced? A national multi-centre cross-sectional study on frequency of visual field testing in glaucoma

Fung

Lemer²,

Russell

et al. 2013

Br J Ophthalmol

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Results One-hundred and four patients with COAG were included. 73 patients had at least 2 years of follow-up. Median (IQR) total number of VF tests and in the first 2 years of diagnosis were 4 (2-7) and 2 (2-3), respectively. No patients met EGS guidelines, but 87% of patients had their monitoring intervals requested in accordance with NICE guidelines. These intervals were not related to disease severity or VF stability (KruskalWallis test, p=0.25) but shortened significantly when IOP control was inadequate or when the overall clinical impression was disease progression ( p<0.001). Permanent repository linkConclusions Most newly-diagnosed COAG patients receive less than three VFs in the first 2 years following diagnosis and an average of 0.7 VF per year over the duration of follow-up.

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“…To make a proper estimate of the life expectancy of glaucoma patients, life expectancy should be adjusted for the age already reached, a concept known as residual life expectancy. More importantly, an estimate of the upper limit of life expectation should be taken into account rather than the median residual life expectancy, in order to deal with variability in survival (Wesselink et al, 2011). It is therefore helpful to communicate with the patient’s primary health care provider regarding medical conditions, particularly comorbidities associated with the leading causes of mortality.…”

Section: Measurement Of Visual Field Progressionmentioning

confidence: 99%

Detection and measurement of clinically meaningful visual field progression in clinical trials for glaucoma

Moraes

Liebmann

Levin

2017

Progress in Retinal and Eye Research

154

123

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Glaucomatous visual field progression has both personal and societal costs and therefore has a serious impact on quality of life. At the present time, intraocular pressure (IOP) is considered to be the most important modifiable risk factor for glaucoma onset and progression. Reduction of IOP has been repeatedly demonstrated to be an effective intervention across the spectrum of glaucoma, regardless of subtype or disease stage. In the setting of approval of IOP-lowering therapies, it is expected that effects on IOP will translate into benefits in long-term patient-reported outcomes. Nonetheless, the effect of these medications on IOP and their associated risks can be consistently and objectively measured. This helps to explain why regulatory approval of new therapies in glaucoma has historically used IOP as the outcome variable. Although all approved treatments for glaucoma involve IOP reduction, patients frequently continue to progress despite treatment. It would therefore be beneficial to develop treatments that preserve visual function through mechanisms other than lowering IOP. The United States Food and Drug Administration (FDA) has stated that they will accept a clinically meaningful definition of visual field progression using Glaucoma Change Probability criteria. Nonetheless, these criteria do not take into account the time (and hence, the speed) needed to reach significant change. In this paper we provide an analysis based on the existing literature to support the hypothesis that decreasing the rate of visual field progression by 30% in a trial lasting 12–18 months is clinically meaningful. We demonstrate that a 30% decrease in rate of visual field progression can be reliably projected to have a significant effect on health-related quality of life, as defined by validated instruments designed to measure that endpoint.

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Incorporating life expectancy in glaucoma care

Cited by 23 publications

References 28 publications

Are rates of vision loss in patients in English glaucoma clinics slowing down over time? Trends from a decade of data

Are rates of vision loss in patients in English glaucoma clinics slowing down over time? Trends from a decade of data

Are practical recommendations practiced? A national multi-centre cross-sectional study on frequency of visual field testing in glaucoma

Detection and measurement of clinically meaningful visual field progression in clinical trials for glaucoma

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