Pre-perimetric Open Angle Glaucoma with Young Age of Onset: Natural Clinical Course and Risk Factors for Progression.
Bak Eunoo, Kim Yong Woo, Ha Ahnul, Kim Young Kook, Park Ki Ho, Jeoung Jin Wook
AI Summary
This study found that young-onset pre-perimetric glaucoma progresses structurally in 39% of untreated cases over 5 years, with specific structural and functional factors predicting progression, highlighting the need for early monitoring.
Abstract
Purpose
To investigate the natural clinical course of more than 5 years and the risk factors of progression in patients with pre-perimetric open angle glaucoma (OAG) of "young age of onset (under age 40)" without treatment.
Design
Retrospective observational case series.
Methods
Optic disc photography, red-free retinal nerve fiber layer (RNFL) photography, optical coherence tomography, and visual field (VF) examinations were performed every 6 months. Glaucoma progression was defined as structural or functional deterioration. A linear mixed-effects model was used to estimate the rate of structural and functional changes. Kaplan-Meier survival analysis and log-rank testing were used to compare survival experiences, and Cox proportional hazards modeling was performed to identify risk factors for glaucoma progression.
Results
Of the 98 eyes of 98 patients (mean age, 30.6 years old), glaucoma progression was detected in 42 eyes (42.9%). The rate of average RNFL thickness thinning was -0.46 ± 0.50 μm/y, and the mean deviation (MD) change was -0.03 ± 0.13 dB/y. The glaucoma progression probability at 5 years was 39% by structural criteria and 5% by functional criteria. Older age at diagnosis (P = .004), presence of temporal raphe sign (horizontal straight line on macular ganglion cell-inner plexiform layer thickness map) (P = .011), lamina pore visibility (P = .034), and greater pattern standard deviation (P = .005) were significant factors for glaucoma progression.
Conclusions
In untreated pre-perimetric OAG patients with a "young age of onset" condition, the estimated MD slope for the disease course of more than 5 years was -0.03 dB/y, and the average RNFL thinning rate was -0.46 μm/y. The predictors for progression were structural parameters of temporal raphe sign, lamina pore visibility, and functional parameter of pattern standard deviation.
MeSH Terms
Shields Classification
Key Concepts5
In untreated pre-perimetric open angle glaucoma (OAG) patients with a young age of onset (under age 40), the estimated mean deviation (MD) slope for the disease course of more than 5 years was -0.03 dB/y.
In untreated pre-perimetric open angle glaucoma (OAG) patients with a young age of onset (under age 40), the average retinal nerve fiber layer (RNFL) thinning rate was -0.46 ± 0.50 μm/y over a disease course of more than 5 years.
Glaucoma progression was detected in 42.9% (42 out of 98 eyes) of untreated pre-perimetric open angle glaucoma (OAG) patients with a young age of onset (under age 40) over a disease course of more than 5 years.
The probability of glaucoma progression at 5 years in untreated pre-perimetric open angle glaucoma (OAG) patients with a young age of onset (under age 40) was 39% by structural criteria and 5% by functional criteria.
Older age at diagnosis (P = .004), presence of temporal raphe sign (P = .011), lamina pore visibility (P = .034), and greater pattern standard deviation (P = .005) were significant risk factors for glaucoma progression in untreated pre-perimetric open angle glaucoma (OAG) patients with a young age of onset (under age 40).
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