Manifest Glaucoma in the Aged I: Occurrence Nine Years After a Population Survey

Abstract

The present study was based on already existing clinical data concerning 599 persons born before 1907, examined during a general ophthalmic survey 1969-72 and still remaining in the same district in July 1980. At the survey 1969-72, 19 out of 1057 persons had manifest glaucoma, 14 were already treated for ocular hypertension, 54 had an IOP greater than 20.5 mmHg and 970 were considered normal. Immediately after the survey, 17 patients were treated for manifest glaucoma and 19 for ocular hypertension. During the following 9 years treated persons were lost to a greater extent (64%) than untreated persons (43%). In July 1980 only 6 persons treated for manifest glaucoma since the survey remained, and 3 of them were socially blind. One out of 7 treated and 2 out of 28 untreated persons with ocular hypertension at the survey had developed visual field defects 9 years later. Manifest glaucomas, often advanced cases, were also detected in 9 persons considered normal at the survey. 5 out of 12 persons with manifest glaucoma detected after the survey had an IOP less than 20.5 mmHg at detection. The visual capacity of persons still remaining in the district 1980 was largely independent of all efforts to prevent blindness from glaucoma in the present population.

Glaucoma Screening a 16‐year Follow‐up of Ocular Normotensives

“…In Perkins material (1973), 4 out of 770 persons developed GVFD after 5-7 years observation giving an incidence of 0.52%. Bengtsson (1981) found GVFDs in 9 out of 556 persons after an observation period of 9 years giving an incidence of 1.62%. A statistical comparison is difficult due to differences in visual field testing techniques and varying observation periods.…”

Ocular hypertension

“…Ocular hypertension as a prognostic factor in developing glaucoma has previously been investigated in long-term studies with a follow-up time between 5 and 20 years (Hollows & Graham 1966;Armaly 1969;Norskov 1970, Perkins 1973Wilensky et al 1974;Kitazawa et al 1977;Serensen et al 1978;Bengtsson 1981;Hevding & Aasved 1986).…”

Prognostic factors in the development of manifest open angle glaucoma

“…A raised intraocular pressure (IOP) without clinical signs of optic nerve damage is often termed 'ocular hypertension' instead of glaucoma, while the term 'manifest glaucoma' is applied to patients with glaucomatously excavated optic discs and/or glaucomatous visual field defects (Hollows & Graham 1966;Bengtsson 1981). However, the relevance of such a clinical classification has been questioned by the recent demonstration of exten-sive retinal nerve fiber layer damage in the absence of clinically manifest glaucoma (Quigley et al 1980;Quigley 1982;Airaksinen & Tuulonen 1984;Sommer et al 1984).…”

“…Although several studies seem to indicate that patients with a moderate ocular hypertension do not require anti-glaucomatous treatment (Linner 1976;SGrensen et al 1978;Bengtsson 1981), it is still generally held that the prognosis of eyes with a raised IOP depends significantly upon the degree of pressure elevation (Schappert-Kimmijser 1971;Kitazawaet al 1977;Spaeth 1979).…”

“…In addition to the IOP, other factors influencing the retinal and optic nerve blood supply are also obviously correlated to the development of manifest glaucoma. According to Bengtsson et al (1981), disc haemorrhages are highly specific for a glaucomatous process. Eyes with fibrillopathy (pseudoexfoliation) also run higher risk of developing manifest glaucomatous damage (Aasved 1971b;Kozart & Yanoff 1982), while the prognostic importance of tonography and water drinking test remains uncertain (Leydhecker 1973;Rasmussen & J@rgensen 1976;S@rensen et al 1978;Armaly et al 1980).…”