Lifetime visual prognosis for patients with primary open-angle glaucoma

Abstract

Aim To investigate final visual outcome in primary open angle glaucoma (POAG) including low-tension glaucoma (LTG). Methods Retrospective review of case notes for patients who died between 1999 and 2002. All were booked for a follow-up appointment in glaucoma clinic at time of death. Results A total of 121 case notes were reviewed. In all, 113 patients had POAG and eight had LTG. All were White Caucasians. Mean ages at presentation and death were 74.6 (SD 9.6, range 49-94) and 81.9 (SD 8.3, range 51-98) years, respectively. Mean follow-up duration was 7.4 (SD 6.8, range up to 29) years. Average number of clinic visits was 18 (SD 17, range 1-95). At final visit, 50.4% had cataract operations, and 45.5% had glaucoma operations. At final visit, vision was inadequate for driving in the UK in 47.1%. In 18.2%, this was due to glaucoma alone, while in 28.9%, other ocular pathologies contributed to poor vision. In all, 14% were eligible for partial sight certification, with 6.6% due to glaucoma alone. A total of 3.3% were eligible for blind certification, none due to glaucoma alone. Conclusion This study shows that POAG does affect the quality of life, with regards to glaucoma clinic visits, eye drops, and surgical procedures. Most patients with treated POAG in Norfolk will retain useful vision for their whole life. A significant proportion of patients with POAG do lose vision resulting in driving ineligibility and certification as visually impaired, although actual blindness is uncommon.

A Systematic Review of End-of-Life Visual Impairment in Open-Angle Glaucoma: An Epidemiological Autopsy

“…The number of blind patients differed substantially between the studies; with the lowest percentage of blind patients (0% blindness) in the study of Ang and Eke, 3 and the highest percentage of blind patients (24% unilateral blindness and 10% bilateral blindness) in the study of Peters et al 4 ( Table 2). The percentage of blind patients was higher, for example, 26% unilateral blindness 11 in the presence of other ocular diseases, mainly age-related macular degeneration and cataract.…”

“…Five articles were discussed further in this review. [2][3][4]11,12 IOP data from the study of Ernest et al 12 was retrieved from our own data and through oral communication with the author P. J. G. Ernest. The study of Peters et al 4 did not provide IOP data at last visit.…”

“…If patients were lost to follow-up and it was therefore unknown if they had died, they were excluded. 2,3,11 Patients were also excluded if the time between death and last visit was too long. 4 The studies do not provide information on whether these patients were out of care or visited another ophthalmologist or more presumably a facility for low-vision aid.…”

“…[1][2][3][4] It is defined as an optic neuropathy that is characterized by typical optic nerve head changes with corresponding visual field (VF) defects. 1,2,5 Glaucoma is a slowly progressive disease that can lead to blindness.…”

Incorporating life expectancy in glaucoma care

“…As it tends to have a low speed of progression, some patients will not become visually impaired during their lifetime. 1 If patients with a near-zero risk of visual impairment could be identified, a source of excess treatment and excess monitoringFwith all its side effects and costsFcould be identified as well. The occurrence of future visual impairment (depicted as a certain amount of visual field loss) can be predicted from the current visual field loss of a patient together with his or her rate of progression.…”