Glaucoma likely to end in visual impairment

By Sarah Guy, medwireNews Reporter

Visual impairment at the end of life is highly likely to occur in patients with glaucoma, show Dutch study results.

Findings from the 9-year follow-up study indicate that just over a quarter of individuals with open-angle glaucoma (OAG) become visually impaired at the end of life, with some instances resulting from visual field loss, and some from a loss of visual acuity.

Most cases of end-of-life visual impairment were caused by ocular comorbidity, note the researchers, with age-related macular degeneration the most common comorbidity.

"Most patients with an end-of-life visual impairment caused by glaucoma had already substantial vision loss at the initial visit. This indicates a delayed presentation of glaucoma to the ophthalmologist with a subsequent delay in glaucoma treatment," say Paul Ernest (University Eye Clinic Maastricht) and colleagues in Acta Ophthalmologica.

In all, 122 patients who died between July 2008 and July 2010 and who made at least two visits to an outpatient ophthalmology clinic in the last 2 years of life for glaucoma-related issues comprised the study population. The mean follow-up period was 9.2 years.

A total of 61 patients were initially diagnosed as having OAG, and 61 were suspected of having OAG, or had ocular hypertension (OHT). Visual function was measured by Snellen visual acuity and visual field tests, with visual impairment defined as a binocular moderate visual impairment category 1 or more in the World Health Organization's International Classification of Diseases-10, which equates to a Snellen score of less than 0.3, or 20/60.

Visual impairment was evident in 26% of OAG patients and 8% of OHT patients in the last 2 years of life, report Ernest et al. Eight (15%) OAG patients had an impairment resulting from visual field loss, and 16% had impairment arising from loss in visual acuity.

Among those with OAG, nine (15%) had a visual impairment resulting from glaucomatous disease, eight of whom had already displayed substantial vision loss at their initial ophthalmologist visit. Six visual impairments in OAG patients were explained by ocular comorbidity.

By contrast, the visual impairment in individuals with suspected OAG or OHT was explained by ocular comorbidities in all cases, most often by age-related macular degeneration, note the authors.

"This study shows that the eventual risk of visual impairment is considerable for patients followed for glaucoma," conclude the researchers.

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