Comparison of disease severity in glaucoma patients identified by screening in the 1990s and in routine clinical care in the 2010s in Sweden.
Bengtsson B, Villalba C, Peters D, Aspberg J
AI Summary
Comparing glaucoma severity, routine clinical diagnoses in the 2010s showed improved visual fields versus 1990s screening, but severe damage at presentation remains unacceptably high, increasing blindness risk.
Abstract
Background and purpose: In a previous study comparing the amount of visual field damage at presentation in patients having open-angle glaucoma (OAG) identified through screening and in patients diagnosed in routine clinical practice in the 1990s, the damage was considerably worse in the clinically diagnosed patients. In the present study we compare visual field damage at presentation in the same 402 screened patients with that seen in 281 newly detected previously untreated patients clinically diagnosed in the 2010s.
Methods
The perimetric visual field index mean deviation (MD) was compared in the two groups of patients.
Results
In the clinical patients diagnosed with bilateral visual field damage the median MD was -5.1 dB in the better eye and -13.0 dB in the worse eye. In the screened patients the median MD in the better eye was -6.5 dB and -11.5 dB in the worse eye. The differences between the clinical and screened patients were non-significant, p = 0.28 and p = 0.67 respectively. More clinical patients had severe visual field loss, defined as MD less than -20 dB, in the worse eye than in the screened patients, 18.5% versus 12.7% respectively, p = 0.037.
Conclusion
The visual field damage at presentation in clinically diagnosed OAG patients has improved in the past 20 years, but the proportion of patients with severe visual field loss in at least one eye, almost 20%, is still unacceptably high considering that severe visual field damage at presentation is the most important risk factor for later development of glaucoma blindness.
MeSH Terms
Shields Classification
Key Concepts4
In a comparison of visual field damage at presentation, clinically diagnosed open-angle glaucoma (OAG) patients from the 2010s (n=281) had a median visual field index mean deviation (MD) of -5.1 dB in the better eye and -13.0 dB in the worse eye, while screened OAG patients from the 1990s (n=402) had a median MD of -6.5 dB in the better eye and -11.5 dB in the worse eye.
The differences in median visual field index mean deviation (MD) between clinically diagnosed open-angle glaucoma (OAG) patients from the 2010s (n=281) and screened OAG patients from the 1990s (n=402) were non-significant for the better eye (p=0.28) and the worse eye (p=0.67).
More clinical patients diagnosed with open-angle glaucoma (OAG) in the 2010s (n=281) had severe visual field loss, defined as mean deviation (MD) less than -20 dB, in the worse eye compared to screened OAG patients from the 1990s (n=402), with 18.5% versus 12.7% respectively (p=0.037).
The proportion of clinically diagnosed open-angle glaucoma (OAG) patients with severe visual field loss (MD < -20 dB) in at least one eye, almost 20%, is still unacceptably high, considering that severe visual field damage at presentation is the most important risk factor for later development of glaucoma blindness.
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