Purpose: To determine the probability of worsening of glaucoma and the rate of change in patients having open-angle glaucoma for approximately 20 years.
Design: Retrospective, noncomparative case series.
Participants: One hundred and two patients diagnosed and treated for open-angle glaucoma before 1982. TESTING/INTERVENTION: The optic disc and visual field of one eye of each patient were graded independently at diagnosis and periodically throughout the follow-up period for a minimum of 15 years (mean, 19 +/- 3 years), using a scale ranging from 0 = no damage to 5 = far-advanced damage. Therapy was contemperaneous and stepped through medical laser, and surgery.
Main outcome measures: The probability of worsening by one or more stages was plotted against the length of follow-up (Kaplan-Meier survival curves).
Results: Nineteen eyes did not worsen, 43 deteriorated one stage, 31 two stages, and 9 three stages. The median time to first worsening was 7.5 years, to second worsening 18.5 years, and to third worsening 24.5 years. Patients with more advanced stages of damage were not more likely to deteriorate than those with less-marked damage. The intraocular pressure was not significantly lower in the patients who remained stable. Seventeen eyes deteriorated to a visual acuity of 20/200 or worse. Of these, causes other than glaucoma were responsible in at least 60% of the cases.
Conclusions: Approximately 20% of eyes with open-angle glaucoma remained stable for about 20 years, 43% deteriorated one of five stages, and 9% three of five stages. Seventeen of the eyes lost acuity to a level of 20/200, usually from causes other than glaucoma. Deterioration of field was, on average, first noted at 7.5 years, after which the rate of deterioration slowed.