Original article
Predictive Factors for Progressive Optic Nerve Damage in Various Types of Chronic Open-angle Glaucoma

https://doi.org/10.1016/j.ajo.2004.12.056Get rights and content

Purpose

To evaluate whether various types of chronic open-angle glaucoma differ in predictive factors for progression of glaucomatous optic nerve damage.

Design

Observational cohort study.

Methods

setting: Prospective observational clinical study. patients: 517 eyes of 300 Caucasian patients with chronic open-angle glaucoma with elevated intraocular pressure (primary open-angle glaucoma, n = 289; secondary open-angle glaucoma, n = 50) and with normal intraocular pressure (n = 178). observation procedure: During follow-up (median: 49 months, 6 months-130 months), all patients underwent repeated evaluation of color stereo optic disk photographs and white-on-white visual field examination. main outcome measures: Progression of glaucoma was defined as neuroretinal rim loss during the study period.

Results

For patients with elevated intraocular pressure, significantly predictive factors for eventual progression were older age, advanced perimetric damage, smaller neuroretinal rim, and larger area of β zone of parapapillary atrophy. In contrast, in the normal intraocular pressure group, a significant predictive factor was presence of disk hemorrhages at baseline. Within the patients with elevated intraocular pressure, the primary open-angle glaucoma group and the secondary open-angle glaucoma group did not differ in predictive factors for progression of glaucoma.

Conclusions

Open-angle glaucoma patients with normal intraocular pressure and open-angle glaucoma patients with elevated intraocular pressure differ in predictive factors for eventual progression of glaucomatous optic nerve damage. It may have clinical importance and may be helpful in the discussion of the pathogenesis of the glaucomas.

Section snippets

Methods

The present study is a secondary analysis of a prospectively planned investigation. Recruitment and observations were performed according to a standardized protocol. The scientific question primarily assessed was the identification of predictive factors for progression of chronic open-angle glaucoma. In the present analysis, we investigated whether various types of chronic open-angle glaucoma differ in their predictive factors for progression of glaucomatous optic nerve damage.

Results

A detailed description of follow-up, censoring, and dropouts is given in Table 4. The median follow-up time was 49 months (6 months-130 months). For 94 (18.2%) of 517 eyes and 75 (25%) of 300 patients, progression of glaucomatous optic nerve damage was detected (TABLE 2, TABLE 3). After 8 years, the Kaplan-Meier estimate for progression of glaucoma was 32.5% (CI: 23.9%-41.02%). Progression was observed in 37 (20.8%) of 178 eyes with normal intraocular pressure, in 57 (16.8%) of 339 eyes with

Discussion

The risk factors identified in the present study were predictive for morphologic progression of glaucoma. Other factors may be predictive for functional progression.

For patients with elevated intraocular pressure, predictive factors at baseline of the study for eventual progression during follow-up were advanced optic nerve damage (measured as pronounced perimetric damage and small neuroretinal rim), large β zone of parapapillary atrophy, and older age. Initial optic disk hemorrhages were not

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