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Natural history of open-angle glaucoma.
Ophthalmology 2009; 116(12):2271-6O

Abstract

OBJECTIVE

This article, based on the Early Manifest Glaucoma Trial (EMGT), provides prospective natural history data on progression of glaucomatous field defects in 3 of the most common glaucoma types.

DESIGN

Cohort of EMGT patients randomized to the untreated control group and followed up to the time of progression, when treatment could be initiated.

PARTICIPANTS

We evaluated 118 control patients: 46 with high-tension glaucoma (HTG), 57 with normal-tension glaucoma (NTG), and 15 with pseudoexfoliation glaucoma (PEXG).

METHODS

Visual fields were tested every 3 months with the Humphrey 30-2 Full Threshold test program.

MAIN OUTCOME MEASURES

Linear regression analyses of the perimetric mean deviation (MD) values were performed, and the rate of progression was defined as the regression coefficient in decibels per year. Percentages of progressed eyes and time to progression were determined using EMGT event-based predetermined progression criteria derived from Glaucoma Change Probability Maps.

RESULTS

The median and interquartile rates of visual function loss were -0.40 (1.05) dB/year overall and -0.46 (1.61) in HTG, -0.22 (0.65) in NTG, and -1.13 (6.13) in PEXG. Thus, interpatient variability was large. Mean rates were considerably higher than medians: -1.08 dB/year overall, -1.31 in HTG, -0.36 in NTG, and -3.13 in PEXG. Differences in median visual function progression rates among groups were statistically significant (NTG vs. HTG, P = 0.003; PEXG vs. non-PEXG, P<0.001). Progression was considerably and significantly faster in older than in younger patients (P = 0.002). By 6 years, 68% of patients had progressed overall, 74% of those with HTG, 56% of those with NTG, and 93% of those with PEXG (P = 0.012). Median time to progression also differed considerably among groups: 19.5 months in PEXG, 44.8 months in HTG, and particularly 61.1 months in NTG (P<0.0001).

CONCLUSIONS

In this 6-year follow-up study, the median untreated rate of progression corresponded to advancing from normal visual function to blindness in approximately 70 years, whereas on the basis of the mean rate, visual function would show the same deterioration in approximately 25 years. Large differences existed among patients and different glaucoma types, with PEXG progressing considerably faster than HTG, and NTG progressing at the lowest rate.

Authors+Show Affiliations

Department of Ophthalmology, Lund University, Malmö University Hospital, Malmö, Sweden. anders.heijl@med.lu.se

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19854514

Citation

Heijl, Anders, et al. "Natural History of Open-angle Glaucoma." Ophthalmology, vol. 116, no. 12, 2009, pp. 2271-6.
Heijl A, Bengtsson B, Hyman L, et al. Natural history of open-angle glaucoma. Ophthalmology. 2009;116(12):2271-6.
Heijl, A., Bengtsson, B., Hyman, L., & Leske, M. C. (2009). Natural history of open-angle glaucoma. Ophthalmology, 116(12), pp. 2271-6. doi:10.1016/j.ophtha.2009.06.042.
Heijl A, et al. Natural History of Open-angle Glaucoma. Ophthalmology. 2009;116(12):2271-6. PubMed PMID: 19854514.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Natural history of open-angle glaucoma. AU - Heijl,Anders, AU - Bengtsson,Boel, AU - Hyman,Leslie, AU - Leske,M Cristina, AU - ,, Y1 - 2009/10/24/ PY - 2008/11/24/received PY - 2009/06/18/revised PY - 2009/06/19/accepted PY - 2009/10/27/entrez PY - 2009/10/27/pubmed PY - 2009/12/16/medline SP - 2271 EP - 6 JF - Ophthalmology JO - Ophthalmology VL - 116 IS - 12 N2 - OBJECTIVE: This article, based on the Early Manifest Glaucoma Trial (EMGT), provides prospective natural history data on progression of glaucomatous field defects in 3 of the most common glaucoma types. DESIGN: Cohort of EMGT patients randomized to the untreated control group and followed up to the time of progression, when treatment could be initiated. PARTICIPANTS: We evaluated 118 control patients: 46 with high-tension glaucoma (HTG), 57 with normal-tension glaucoma (NTG), and 15 with pseudoexfoliation glaucoma (PEXG). METHODS: Visual fields were tested every 3 months with the Humphrey 30-2 Full Threshold test program. MAIN OUTCOME MEASURES: Linear regression analyses of the perimetric mean deviation (MD) values were performed, and the rate of progression was defined as the regression coefficient in decibels per year. Percentages of progressed eyes and time to progression were determined using EMGT event-based predetermined progression criteria derived from Glaucoma Change Probability Maps. RESULTS: The median and interquartile rates of visual function loss were -0.40 (1.05) dB/year overall and -0.46 (1.61) in HTG, -0.22 (0.65) in NTG, and -1.13 (6.13) in PEXG. Thus, interpatient variability was large. Mean rates were considerably higher than medians: -1.08 dB/year overall, -1.31 in HTG, -0.36 in NTG, and -3.13 in PEXG. Differences in median visual function progression rates among groups were statistically significant (NTG vs. HTG, P = 0.003; PEXG vs. non-PEXG, P<0.001). Progression was considerably and significantly faster in older than in younger patients (P = 0.002). By 6 years, 68% of patients had progressed overall, 74% of those with HTG, 56% of those with NTG, and 93% of those with PEXG (P = 0.012). Median time to progression also differed considerably among groups: 19.5 months in PEXG, 44.8 months in HTG, and particularly 61.1 months in NTG (P<0.0001). CONCLUSIONS: In this 6-year follow-up study, the median untreated rate of progression corresponded to advancing from normal visual function to blindness in approximately 70 years, whereas on the basis of the mean rate, visual function would show the same deterioration in approximately 25 years. Large differences existed among patients and different glaucoma types, with PEXG progressing considerably faster than HTG, and NTG progressing at the lowest rate. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/19854514/Natural_history_of_open_angle_glaucoma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(09)00670-8 DB - PRIME DP - Unbound Medicine ER -