Abstract
PurposeTo evaluate frequency, conversion rate, and risk factors for blindness in glaucoma patients treated in European Universities.MethodsThis multicenter retrospective study included 2402 consecutive patients with glaucoma in at least one eye. Medical charts were inspected and patients were divided into those blind and the remainder (‘controls’). Blindness was defined as visual acuity≤0.05 and/or visual field loss to less than 10°.ResultsUnilateral and bilateral blindness were respectively 11.0% and 1.6% at the beginning, and 15.5% and 3.6% at the end of the observation period (7.5±5.5 years, range:1–25 years); conversion to blindness (at least unilateral) was 1.1%/year. 134 eyes (97 patients) developed blindness by POAG during the study. At the first access to study centre, they had mean deviation (MD) of -17.1±8.3 dB and treated intraocular pressure (IOP) of 17.1±6.6 mmHg. During follow-up the IOP decreased by 14% in these eyes but MD deteriorated by 1.1±3.5 dB/year, which was 5-fold higher than controls (0.2±1.6 dB/year). In a multivariate model, the best predictors for blindness by glaucoma were initial MD (p<0.001), initial IOP (p<0.001), older age at the beginning of follow-up (p<0.001), whereas final IOP was found to be protective (p<0.05).ConclusionsIn this series of patients, blindness occurred in about 20%. Blindness by glaucoma had 2 characteristics: late diagnosis and/or late referral, and progression of the disease despite in most cases IOP was within the range of normality and target IOP was achieved; it could be predicted by high initial MD, high initial IOP, and old age.
Highlights
The socio-economic impact of glaucoma is very high mainly due to its epidemiology and the effects on visual function
During follow-up the intraocular pressure (IOP) decreased by 14% in these eyes but mean deviation (MD) deteriorated by 1.1±3.5 dB/year, which was 5-fold higher than controls (0.2±1.6 dB/year)
Blindness and Glaucoma most cases IOP was within the range of normality and target IOP was achieved; it could be predicted by high initial MD, high initial IOP, and old age
Summary
The socio-economic impact of glaucoma is very high mainly due to its epidemiology and the effects on visual function. A recent review found that glaucoma is responsible for 10–11% of blindness in Western Europe and U.S, and this percentage is increasing in the last decade [2]. Progressive glaucomatous visual field (VF) impairment is associated with reduced vision-related quality of life [3,4] and higher social costs [5]. The visual outcome is the major concern of glaucoma patients [6]. 34% are worried about the probability of becoming blind in the future; even if this percentage decreases to 11% at follow-up, fear is still very high for patients with severe field deterioration and progression [7]
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