Will my Glaucoma patient lose vision ?

1. RohitVarma, MD, MPH Professor and Chairman Illinois Eye and Ear Infirmary Univ. of Illinois at Chicago Will my Glaucoma patient lose vision ?

2. Disclosure I have no financial disclosures related to the content of this talk National Institutes of Health Grants: NEI U10-EY-11753 and EY-03040 and an unrestricted grant from the Research to Prevent Blindness, New York, NY.

3. Worldwide burden of Glaucoma • Glaucoma is the leading cause of irreversible blindness in the world, estimated to affect up to 79.6 million people by 2020. • Of these, 74% have POAG and 26% have primary angle-closure glaucoma (PACG).

4. POAG related Blindness • Blindness from POAG in at least 1 eye of between 15% and 27% after 15 to 20 years of follow-up • 20% over a 34-year follow-up period.

5. POAG related VF Progression • VF progression of between 21% and 44% over 10 years in US • 16% to 37% of treated POAG patients experienced progressive VF loss over a 5-year period in Australia.

6. Comparison of Glaucoma Blind vs. Non-Blind Persons Oliver et al 2002

7. Comparison of Glaucoma Blind vs. Non-Blind Persons • The mean IOP on therapy in the patients progressing to blindness was lower than, or similar to, those who did not become blind. • The group progressing to blindness had a greater variability of IOP while on therapy than the non-blind group. • Even in patients with low IOP, however, glaucoma could progress.

8. Comparison of Glaucoma Blind vs. Non-Blind Persons • The different sensitivities of patients to IOP indicate that ongoing monitoring of glaucomatous damage remains essential. • While establishment of a target IOP is a cornerstone of modern glaucoma practice, such target pressures should be adjusted if the patients’ condition changes.

9. Predictors for Progressive Visual Field Loss

10. IOP and Progressive Visual Field Loss

11. Glaucoma With Early Visual Field Loss Affecting Both Hemi-fields and the Risk of Disease Progression De Moraes et al 2009

12. Glaucoma With Early Visual Field Loss Affecting Both Hemi-fields and the Risk of Disease Progression

13. Factors for Glaucoma Progression and the Effect of Treatment: The Early Manifest Glaucoma Trial

14. Risk Factors for the Progression of Open-angle Glaucoma: Canadian Glaucoma Study

15. Progressive VF Loss - CIGTS • After 8-year of follow-up substantial worsening (≥3 dB) of Visual fields was found in 21.3% and 25.5% of the initial surgery and initial medicine groups. • In patients with advanced visual field loss, Initial surgery led to less VF progression than initial medicine • Persons with diabetes had more VF loss over time if treated initially with surgery.

16. POAG related Blindness and Progressive VF Loss • Higher IOP and Greater Variability of IOP • Greater Visual Field Loss at baseline • Diabetes • Low ocular perfusion pressure • In advanced cases, treatment with medicine vs. surgery

17. PACG and Progressive VF Loss • Progression of Visual Field defects in 10% of treated PACG eyes over 6 years of follow-up. • Another study examining 101 patients with chronic PACG reported progression in 25% of patients over 5 years.

18. PACG and Progressive Visual Field Loss

19. Risk Factors for Progressive Visual Field Loss in PACG

20. PACG related Blindness and Progressive VF Loss • Higher IOP • Previous Episodes of Acute angle closure • Not enough data

21. Will my glaucoma patient lose vision? Summary Primary Open Angle Glaucoma Higher IOP and greater variation of IOP Greater initial visual field loss Diabetes Pseudoexfoliation Treatment with medication compared with surgery

22. Will my glaucoma patient lose vision? Summary Primary Angle Closure Glaucoma Higher IOP Previous episodes of acute angle closure

23. Thank you