Risk Factors Associated with Progression to Blindness from Primary Open-Angle Glaucoma in an African-American Population.
Risk Factors Associated with Progression to Blindness from Primary Open-Angle Glaucoma in an African-American Population.
复制标题
DOI：
10.1080/09286586.2016.1193207
复制
发表时间：
2016-08
影响因子：
1.8
通讯作者：
O'Brien JM
中科院分区：
文献类型：
--
作者：
Pleet A;Sulewski M;Salowe RJ;Fertig R;Salinas J;Rhodes A;Merritt Iii W;Natesh V;Huang J;Gudiseva HV;Collins DW;Chavali VR;Tapino P;Lehman A;Regina-Gigiliotti M;Miller-Ellis E;Sankar P;Ying GS;O'Brien JM
确定非洲裔美国人原发性开角型青光眼（POAG）进展至失明的相关风险因素。本研究检查了2119例参加原发性开角型非裔美国人青光眼遗传学（POAAGG）研究的患者。共有59只眼睛被确定为合法失明的POAG（病例），年龄和性别匹配的59个非盲眼青光眼（对照）。进行图表审查，以记录已知和疑似风险因素。POAG的诊断年龄早于对照组（p = 0.005）。本组59眼中，16眼（27.1%）诊断时为盲。病例在诊断时视力（VA）较差（p < 0.0001），VA低于20/40时，进展为失明的风险增加27倍（p = 0.0005）。盲眼在诊断时也表现出更多的视野缺损（p = 0.01）、更高的治疗前眼内压（IOP; p < 0.0001）和更高的杯盘比（p = 0.006）。眼压控制较差的病例中，超过20%的随访访视时眼压≥21 mmHg的患者失明的可能性是其他患者的73倍（p < 0.0001）。病例每年错过的预约次数更多（p = 0.003），并且在其图表中发现的不依从问题比对照组更频繁（p = 0.03）。然而，其他依从性数据在组间无显著差异。接受治疗、初始视力低于20/40和眼压控制不佳是POAG致盲的主要危险因素。未来的研究应该检查更早，更有效的青光眼筛查方法，以及遗传学在这些明显年轻的失明患者中的作用。
To determine the risk factors associated with progression to blindness from primary open-angle glaucoma (POAG) in an African-American population. This study examined 2119 patients enrolled in the Primary Open-Angle African-American Glaucoma Genetics (POAAGG) study. A total of 59 eyes were identified as legally blind as a result of POAG (cases) and were age-and sex-matched to 59 non-blind eyes with glaucoma (controls). Chart reviews were performed to record known and suspected risk factors. Cases were diagnosed with POAG at an earlier age than controls (p = 0.005). Of the 59 eyes of cases, 16 eyes (27.1%) presented with blindness at diagnosis. Cases had worse visual acuity (VA) at diagnosis (p < 0.0001), with VA worse than 20/40 conferring a 27 times higher risk of progression to blindness (p = 0.0005). Blind eyes also demonstrated more visual field defects (p = 0.01), higher pretreatment intraocular pressure (IOP; p < 0.0001), and higher cup-to-disc ratio (p = 0.006) at diagnosis. IOP was less controlled in cases, and those with IOP ≥21 mmHg at more than 20% of follow-up visits were 73 times more likely to become blind (p < 0.0001). Cases missed a greater number of appointments per year (p = 0.003) and had non-adherence issues noted in their charts more often than controls (p = 0.03). However, other compliance data did not significantly differ between groups. Access to care, initial VA worse than 20/40, and poor control of IOP were the major risk factors associated with blindness from POAG. Future studies should examine earlier, more effective approaches to glaucoma screening as well as the role of genetics in these significantly younger patients who progress to blindness.