A Systematic Review of End-of-Life Visual Impairment in Open-Angle Glaucoma: An Epidemiological Autopsy.
Mokhles Palwasha, Schouten Jan S A G, Beckers Henny J M, Azuara-Blanco Augusto, Tuulonen Anja, Webers Carroll A B
AI Summary
This review found treated glaucoma patients still experience significant end-of-life blindness (up to 24% unilateral, 10% bilateral), often linked to advanced disease, IOP fluctuations, and poor compliance, highlighting prevention needs.
Abstract
Purpose
Glaucoma patients are still at risk of becoming blind. It is of clinical significance to determine the risk of blindness and its causes to prevent its occurrence. This systematic review estimates the number of treated glaucoma patients with end-of-life visual impairment (VI) and blindness and the factors that are associated with this.
Methods
A systematic literature search in relevant databases was conducted in August 2014 on end-of-life VI. A total of 2574 articles were identified, of which 5 on end-of-life VI. Several data items were extracted from the reports and presented in tables.
Results
All studies had a retrospective design. A considerable number of glaucoma patients were found to be blind at the end of their life; with up to 24% unilateral and 10% bilateral blindness. The following factors were associated with blindness: (1) baseline severity of visual field loss: advanced stage of glaucoma or substantial visual field loss at the initial visit; (2) factors influencing progression: fluctuation of intraocular pressure (IOP) during treatment, presence of pseudoexfoliation, poor patient compliance, higher IOP; (3) longer time period: longer duration of disease and older age at death because of a longer life expectancy; and (4) coexistence of other ocular pathology.
Conclusions
Further prevention of blindness in glaucoma patients is needed. To reach this goal, it is important to address the risk factors for blindness identified in this review, especially those that can be modified, such as advanced disease at diagnosis, high and fluctuating IOP, and poor compliance.
MeSH Terms
Shields Classification
Key Concepts5
A systematic review of 5 articles on end-of-life visual impairment found that up to 24% of glaucoma patients experienced unilateral blindness and up to 10% experienced bilateral blindness at the end of their lives.
Factors associated with blindness in glaucoma patients at the end of life include baseline severity of visual field loss (advanced stage of glaucoma or substantial visual field loss at initial visit), fluctuation of intraocular pressure (IOP) during treatment, presence of pseudoexfoliation, poor patient compliance, higher IOP, longer duration of disease, older age at death, and coexistence of other ocular pathology.
To prevent blindness in glaucoma patients, it is important to address modifiable risk factors such as advanced disease at diagnosis, high and fluctuating intraocular pressure (IOP), and poor patient compliance.
A systematic literature search was conducted in August 2014 on end-of-life visual impairment, identifying 2574 articles, of which 5 were on end-of-life visual impairment in glaucoma patients.
All studies included in a systematic review of end-of-life visual impairment in open-angle glaucoma had a retrospective design.
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