Original articleProgression of visual field loss in untreated glaucoma patients and glaucoma suspects in st. lucia, west indies1, 2☆,
Section snippets
Design
This is a cohort study of visual field progression in untreated glaucoma patients and glaucoma suspects identified from 1986 to 1987. Initially, we intended to compare visual field loss progression between treated and untreated subjects. However, in 1997, few subjects were under active treatment, in part because the infrastructure for subsidized glaucoma care had changed in 1988. We found that only a few patients had undergone surgery and only a few who could afford medications had continued to
Methods
A 1996 feasibility study demonstrated that the subjects’ medical records were available, and it was estimated that approximately 75% of the subjects in the 1986–1987 survey could be located. The survey was approved by the Institutional Review Board of Howard University School of Medicine, and all subjects signed an informed consent form before participating in any part of the study. Multiple attempts were made to contact each of the 364 subjects identified in the 1986–1987 survey as glaucoma
Results
Of the 410 eyes (205 patients) for which data were obtained, 59 right and 64 left eyes were excluded. The final sample consisted of 146 right and 141 left eyes of 155 subjects (47 men and 108 women). The mean age was 52.3 years, with a range of 26 to 85 years. The mean IOPs from the 1997 examination were 21.0 mm Hg (standard deviation [SD] = 4.3; range = 10–39) for right eyes and 21.0 mm Hg (SD = 4.2; range = 12–43) for left eyes. Of the 155 subjects, 81 (52%) had definite glaucomatous visual
Discussion
No standard for identifying progression of glaucomatous visual field loss has been agreed upon, and separating true progression from changes in visual fields due to learning effects, fatigue, and the long-term fluctuation inherent in the test is extremely difficult.6, 9, 11, 12, 13, 14, 15 For a definitive determination of progression, clinical trials often require that three successive fields show a definite change from baseline. In our study, the lack of repeated evaluation for a given
Acknowledgements
We thank the Ministry of Health of St. Lucia for its support, both for the initial survey and the present study. We also acknowledge and thank Zeiss Humphrey (Dublin, California, USA) for donation of the Humphrey Field Analyzer and the International Eye Foundation (Bethesda, Maryland, USA) for donation of the slit-lamp microscope. New World Medical, Inc. (Rancho Cucamanga, California, USA) responded to the problem of lack of adequate surgical treatment found in this study by sponsoring two of
References (35)
- et al.
National survey of the prevalence and risk factors of glaucoma in St. Lucia, West Indies. Part I. Prevalence findings
Ophthalmology
(1989) - et al.
The Collaborative Initial Glaucoma Treatment Studystudy design, methods, and baseline characteristics of enrolled patients
Ophthalmology
(1999) - et al.
Screening for glaucomatous visual field loss with automated threshold perimetry
Am J Ophthalmol
(1987) - et al.
Estimating progression of visual field loss in glaucoma
Ophthalmology
(1997) - et al.
Test-retest variability in glaucomatous visual fields
Am J Ophthalmol
(1989) Scoring systems for measuring progression of visual field loss in clinical trials of glaucoma treatment
Ophthalmology
(1999)- et al.
Assessing the utility of reliability indices for automated visual fields
Ophthalmology
(1989) - et al.
A prospective three-year study of response properties of normal subjects and patients during automated perimetry
Ophthalmology
(1993) - et al.
Rate of progression in open-angle glaucoma estimated from cross-sectional prevalence of visual field damage
Am J Ophthalmol
(1996) - et al.
Rate of visual field loss and long-term visual outcome in primary open-angle glaucoma
Am J Ophthalmol
(2001)
The onset and evolution of glaucomatous visual field defects
Ophthalmology
The rate of progression of scotomas in glaucoma
Am J Ophthalmol
Intraocular pressure and the rate of visual field loss in chronic open-angle glaucoma
Am J Ophthalmol
Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery
Ophthalmology
The probability of blindness from open-angle glaucoma
Ophthalmology
Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures
Am J Ophthalmol
The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma
Am J Ophthalmol
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2014, American Journal of OphthalmologyCitation Excerpt :Their assessment yielded 31% (20/63) of the VFs classified as improved, and this improvement was significantly associated with the extent of IOP reduction. Wilson and associates15 reported that VF improvement occurred in 96% of 24 eyes that had primary open-angle glaucoma and were treated by trabeculectomy. Finally, Parrish and associates16 conducted a masked evaluation of change in optic disc cupping from baseline to 5 years in 348 study eyes of CIGTS participants.
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This work was supported in part by a grant from the Glaucoma Research Foundation, San Francisco, California (O.K.), the Health Future Foundation, Omaha, Nebraska (M.R.W.), and grant NEI EY08208 from the National Eye Institute, National Institutes of Health, Bethesda, Maryland. (P.S.). This manuscript is abstracted from a thesis submitted by M.R.W. to the American Ophthalmological Society.
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InternetAdvance publication at ajo.com May 7, 2002.
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This study was conducted while the principal author was affiliated with the Jules Stein Eye Institute, University of California at Los Angeles and the Charles R. Drew University of Medicine and Science, Los Angeles, California.