An evidence-based assessment of risk factors for the progression of ocular hypertension and glaucoma

PURPOSE

To critically review the existing literature concerning risk factors for progression of ocular hypertension and glaucoma to assist in assigning levels of risk for individual patients.

DESIGN

Evidence-based review.

METHODS

A panel of physicians specializing in treatment of glaucoma patients was convened to critically analyze published population-based studies of ocular hypertension and glaucoma progression. The strength of evidence in support of reported risk factors was weighed.

RESULTS

Many putative risk factors for progression of ocular hypertension or glaucoma have been reported in the literature. The risk factors most strongly supported by evidence are higher intraocular pressure (IOP), greater cup-to-disk ratio, thinner central corneal measurement, and older age. Black race does not appear to be an independent risk factor, although black individuals tend to have thinner corneas, greater cup-to-disk ratios, and higher IOP, which increase their risk. The limited number of studies in which other suspected risk factors are reported prevents drawing firm conclusions about their importance at this time.

CONCLUSIONS

Only a subset of patients with ocular hypertension will eventually develop glaucoma. Decisions regarding the implementation and extent of therapy for ocular hypertension can be difficult and require an understanding of the relative importance of risk factors for progression. This review discusses the strength of evidence supporting reported risk factors and may be useful in assessing the risk for progression of individual patients.

Open-Angle Glaucoma and Systemic Hypertension

PURPOSE

To assess whether systemic hypertension is associated with open-angle glaucoma (OAG) in an older population.

PATIENTS AND METHODS

The Blue Mountains Eye Study examined 3654 subjects aged 49 to 97 years. Hypertension was diagnosed from history in treated subjects or from systolic blood pressure (BP) > or=160 mm Hg or diastolic BP > or=95 mm Hg. OAG was diagnosed from congruous glaucomatous optic disc rim thinning and visual field loss, without reference to intraocular pressure (IOP) level. Ocular hypertension (OH) was defined when IOP was > 21 mm Hg in either eye, among persons without OAG.

RESULTS

Hypertension was present in 45.7% of subjects, OAG in 3.0%, and OH in 5.2%. Hypertension was significantly associated with OAG, after adjustment for OAG risk factors including IOP, odds ratio (OR) 1.56, 95% confidence interval (CI) 1.01-2.40. This relation was strongest in subjects with poorly controlled treated hypertension (OAG prevalence 5.4%), compared with normotensive subjects (OAG prevalence 1.9%), independent of IOP (OR 1.88, CI 1.09-3.25). The population attributable risk for hypertension (20.4%) was higher than for other identified OAG risk factors. The prevalence of OH was 8.1% in subjects with poorly controlled treated hypertension (OR 1.81, CI 1.20-2.73) and 8.2% in untreated hypertension (OR 1.96, CI 1.31-2.95), compared with 4.2% in normotensive subjects.

CONCLUSIONS

Hypertension, particularly if poorly controlled, appears related to a modest, increased risk of OAG, independent of the effect of BP on IOP and other glaucoma risk factors. However, we could not exclude nocturnal hypotensive episodes among treated subjects. Hypertension was also associated with OH, a relationship that could in part reflect the influence of BP on IOP.

Risk factors for elevated intraocular pressure in uveitis

PURPOSE

To determine the prevalence of raised intraocular pressure (IOP) in patients with uveitis and to identify risk factors for raised IOP in patients with uveitis.

PATIENTS AND METHODS

Consecutive case notes of 257 patients (402 eyes) attending a specialist uveitis clinic during a three-month period were reviewed. Patients with raised IOP were identified and further evaluated. Risk factors for raised IOP were determined.

RESULTS

The prevalence of raised IOP in the study eyes was 41.8%. The prevalence of raised IOP requiring treatment was 29.8%. Raised IOP was found in 26.0% of eyes with acute uveitis and 46.1% of eyes with chronic uveitis. This difference was significant (P = 0.002). Similarly the prevalence of raised IOP requiring treatment in acute and chronic uveitis was 15.1% and 33.8%, respectively. This difference was also significant (P = 0.002). Active inflammation was significantly associated with raised IOP (P = 0.031). Steroid usage, increasing age, and number of years since diagnosis were significantly correlated with raised IOP (P = 0.008, P = 0.022, and P = 0.006, respectively); 9.6% of the study eyes developed glaucoma. The majority of these eyes (69.7%) were treated medically. The remainder (30.3%) required both medical and surgical management.

CONCLUSION

Raised IOP is significantly more common in patients with chronic intraocular inflammation than those with acute uveitis. Risk factors for elevated IOP that should enable closer monitoring of 'at-risk' eyes have been identified.

Clinical analysis of 106 cases with elevated intraocular pressure in thyroid-associated ophthalmopathy

PURPOSE

To summarize the clinical manifestation of thyroid-associated ophthalmopathy (TAO) with elevated intraocular pressure (IOP), and to analyze the contributing factors.

METHODS

One hundred and six cases (188 eyes) of ocular hypertension in 339 cases (597 eyes) with TAO were collected from 1994 to 2001 and their clinic manifestations were summarized and analyzed.

RESULTS

It was demonstrated that the incidence of ocular hypertension in TAO was 31.3%, and was more frequently found in the male than in the female. The elevated IOP in TAO was found to be partially related to compression of the eyeball by enlarged extraocular muscles, the elevated intraorbital pressure as result of the proliferation of intraorbital connective tissue and the enlargement as well as swelling of extraocular muscles. It was also related to the severity of TAO other than the course of TAO. The ocular hypertension in most cases can be controlled with reduction of IOP by methylprednisolone or orbital decompression.

CONCLUSION

Specific clinical features were found in TAO patients with ocular hypertension. It should be differentiated with primary glaucoma. The IOP in most cases can be controlled by prompt and effective treatment of TAO.

[IOP spikes following contact transscleral diode laser cyclophotocoagulation]

PURPOSE

To evaluate the incidence of intraocular pressure (IOP) spikes after contact transscleral diode laser cyclophotocoagulation (cyclodiode) and to identify related risk factors.

METHOD

Retrospective study of 116 eyes (110 patients) with refractory glaucoma who underwent cyclodiode. IOP measurement was obtained immediately before and one hour after cyclodiode. We defined an IOP spike as an increase equal or superior to 5 mmHg after laser treatment. We evaluated several potential pre-, intra- and post-operative factors related to the IOP spike occurrence.

RESULTS

Mean IOP decreased one hour after cyclodiode 6.96 mmHg (SD: 8.36) (p<0.001). Overall, we observed 10.8% of IOP spikes. Age, sex, mean energy delivered, pop occurrence and iris colour were not associated with the postoperative IOP spike occurrence. The percentage of IOP spikes was higher in neovascular glaucoma (p=0.074). The IOP spike rate was also higher after retreatment, but the difference compared to the eyes which underwent cyclodiode for the first time was not significant.

CONCLUSIONS

These preliminary results suggest that IOP spike prevention could be considered in neovascular glaucoma scheduled for cyclodiode

Intraocular pressure abnormalities associated with central and hemicentral retinal vein occlusion

OBJECTIVE

To evaluate the prevalence of ocular hypertension (OHT) and glaucoma in patients with central retinal vein occlusion (CRVO) and hemi-CRVO (HCRVO) and of the fall in intraocular pressure (IOP) secondary to CRVO/HCRVO.

DESIGN

Nonrandomized comparative case series.

PARTICIPANTS AND METHODS

We investigated 674 consecutive patients who were initially seen with unilateral CRVO (n = 548) and HCRVO (n = 126) at their onset, with a normal fellow eye. The fellow uninvolved eye in each patient acted as a control. Central retinal vein occlusion and HCRVO were categorized into nonischemic and ischemic. At all visits, patients had a detailed ocular history, as well as a thorough bilateral ocular evaluation, including IOP recording with a Goldmann applanation tonometer; when the diagnosis of OHT or glaucoma was initially uncertain, the 24-hour diurnal IOP was recorded. The observed prevalence rates of OHT and glaucoma among patients with CRVO and HCRVO were compared with those in the general population.

MAIN OUTCOME MEASURES

The prevalence of OHT and glaucoma, and of ocular hypotension secondary to CRVO/HCRVO.

RESULTS

The overall prevalence of glaucoma was 9.9% and of OHT 16.2%. The prevalence of glaucoma/OHT was found to be significantly (P<0.0001) higher in patients with CRVO and HCRVO than in the general population. There was no significant difference in the proportion of patients with glaucoma/OHT among the various types of CRVO/HCRVO (P = 0.156). Forty-eight percent of all patients had lower IOP (>/==" BORDER="0">2 mmHg) in the CRVO/HCRVO eye than in the fellow (uninvolved) eye at their initial evaluation. The prevalence of ocular hypotension was significantly (P<0.0001) higher in patients with glaucoma/OHT not on ocular hypotensive therapy than in patients without glaucoma. Among the patients without glaucoma, the prevalence of ocular hypotension differed significantly among the various types of CRVO/HCRVO (P = 0.007).

CONCLUSIONS

Central retinal vein occlusion and HCRVO have a significant association with glaucoma and OHT and with a subsequent fall in IOP in the involved eye. Few patients with CRVO/HCRVO have high IOP in the involved eye, although many of them do have it in the fellow uninvolved eye. It is important to exclude glaucoma/OHT in the fellow eye of any patient with CRVO/HCRVO; if present, elevated IOP should be treated to reduce the risk of that eye developing (1) CRVO/HCRVO and (2) glaucomatous damage. There may be no benefit to prescribing IOP-lowering drops for involved eyes whose IOP is already normal.

Open-angle glaucoma and systemic thyroid disease in an older population: The Blue Mountains Eye Study

PURPOSE

To assess whether thyroid disease is independently associated with open-angle glaucoma (OAG), using history of thyroid disease and current thyroxine use.

METHODS

The Blue Mountains Eye Study examined 3654 persons, aged 49-97 years. Interviewers collected self-reported history of diagnosis and treatment for thyroid disease. Eye examinations included applanation tonometry, stereoscopic optic disc photography and automated perimetry. OAG was diagnosed from the presence of matching typical glaucomatous field changes and optic disc cupping, independent of intraocular pressure. Associations between thyroid disease (history and treatment) and OAG were assessed in a multivariate model.

RESULTS

Of 324 participants (8.9%) reporting history of thyroid disease, 147 (4.0%) were currently using thyroxine. Although we could not accurately categorize the thyroid disorder for all cases, current use of thyroxine suggests a prior hypothyroid state. All thyroid disease subgroups affected women more frequently than men, P=0.001. OAG was diagnosed in 108 subjects (3.0%) and was more frequent in those reporting past thyroid disease (4.6 vs 2.8%). This relationship was not statistically significant after adjusting for potential confounders, multivariate odds ratio (OR) 1.6; 95% confidence interval (95% CI) 0.9-2.9. OAG was significantly more frequent, however, in subjects reporting current thyroxine use (6.8 vs 2.8%), multivariate OR 2.1; 95% CI 1.0-4.4, or history of thyroid surgery (6.5 vs 2.8%), multivariate OR 2.5; 95% CI 1.0-6.2.

CONCLUSIONS

This population-based study suggests that thyroid disease, indicated by current thyroxine use or past thyroid surgery, could be independently related to OAG.

[Prevalance of open angle glaucoma and ocular hypertension as a risk factor for primary open angle glaucoma in Wroclaw population. Wroclaw Epidemiology Study]

OBJECTIVE

The purpose of the study is to assess the prevalence of various types of open angle glaucoma (OAG) and ocular hypertension (OH) as a risk factor for AOG. The second aim of the study was to determine the detection level of glaucoma in the population of Wroclaw inhabitants aged 40-79.

MATERIAL AND METHODS

The population based cross-sectional sample of 4853 Wroclaw inhabitants aged 40-79 years underwent two stage examination. First stage of the study included medical history interview and five screening tests: tonometry, peripheric anterior chamber depth assessment by Van Herick technique, ocular nerve head (ONH) assessment by stereoscopic ophthalmoscopy, Heidelberg Retina Tomograph (HRT) and Nerve Fiber Analyzer (GDx) investigation. Second stage included complete ophthalmological examination with gonioscopy, static perimetry and 24 hours monitoring of intraocular pressure (IOP), and pachymetry in OH group.

RESULTS

The prevalence of glaucoma in Wroclaw population aged 40-79 years was 1.6%. Open angle glaucoma (OAG) that includes primary open angle glaucoma (POAG), normal pressure glaucoma (NPG) and capsular glaucoma (PEX-glaucoma) was found in 1.53% of the population. Glaucoma detection level was low: 71% of all cases of glaucoma were diagnosed for the first time. The percentage of OH detected in Wrodaw population was 1.9%. Following the criteria of Ocular Hypertension Treatment Study (OHTS) we found that the pachymetric value of central corneal thickness (CCT) in OH group was less than 555 microm (thin cornea) in 12.5%, from 555 microm to 588 microm (normal thickness of central cornea) in 26.14% and more than 588 microm (thick cornea) in 61.36% of the subjects.

CONCLUSIONS

The Wroclaw Epidemiological Study revealed OAG as 91% of overall glaucoma cases. The relatively high percentage of glaucoma cases was diagnosed for the first time. This number is higher than reported by other authors of population studies in white communities. In the OH group the 26.14% of the eyes with normal CCT has increased risk, and the 12.5% eyes with thin cornea has highly increased risk of POAG, according to OHTS results.

Psychometric Validation of the National Eye Institute Visual Function Questionnaire - 25 (NEI VFQ-25) French version: in a population of patients treated for ocular hypertension and glaucoma

OBJECTIVE

Physicians need reliable, valid and sensitive questionnaires to assess QOL related to glaucoma or ocular hypertension. This article presents the psychometric properties of the French version of the National Eye Institute Visual Function Questionnaire - 25 (NEI VFQ-25).

METHODS

A mail survey was sent to 20000 households. The survey identified 581 residents with glaucoma or ocular hypertension. Of these a random sample (n = 204) took part in a telephone survey during which the NEI VFQ-25 was completed by eligible patients (those taking at least one topical treatment for glaucoma or ocular hypertension on the day of the interview). Multi-trait analysis was performed to assess the construct validity of the questionnaire. Internal consistency reliability was assessed using Cronbach's alpha and the average inter-item correlation. Known groups validity was assessed by comparing patients grouped by duration of glaucoma, adjusted for age and gender.

RESULTS

One hundred and seventy-three patients participated in the survey. Analysis of convergent validity showed that all of the items in each scale correlated above 0.40 with their own scale except for the 'driving' scale. The success rate of the discriminant validity ranged from 57.1% to 100% except for the 'driving' scale, which was 7.1%. Cronbach's alpha coefficients were all above 0.70 except the 'driving' score. Participants with glaucoma for less than 20 years consistently had better 'global', 'near vision', 'distant vision', 'driving', 'social function' and 'peripheral vision' scores than those with disease of 20+ years duration, indicating better QOL in patients with a shorter disease duration.

CONCLUSION

The NEI VFQ-25 is a validated instrument to measure vision-targeted QOL in French populations with glaucoma.

[Glaucoma-screening with the Heidelberg Retina Tomograph II]

BACKGROUND

To investigate the clinical usefulness of the Heidelberg Retina Tomograph II (HRT II) in glaucoma-screening.

MATERIAL AND METHODS

HRT II measurements were performed on 53 glaucomatous, 33 normal and 24 glaucoma suspect eyes. HRT II classification ("glaucoma", "borderline" and "normal") was compared to the classification of clinical examination (biomicroscopic indirect papilla examination, applanation tonometry, threshold perimetry) as well as to the classifications determined with threshold perimetry or GDx nerve fibre analysis simulating a screening examination.

RESULTS

HRT II measurements were successful in 82.7 % of the eyes investigated. The diagnostic sensitivity of the HRT II was 60 %. Specificity was 88.8 % and 100 % at different criteria for "disease". HRT II classification corresponded the biomicroscopic classification in 63.7 %. The accordance of the HRT II classification with the GDx and visual field classification was 65.4 % and 64.8 %, respectively. GDx classification corresponded with the clinical and visual field classification in 41 % and 44 %. Significant (p < 0.05) positive correlation was between HRT II parameters cup/disc area ratio, linear C/D ratio and visual field indices MD and PSD. The HRT II parameter: Retinal Nerve Fibre Layer Cross Sectional Area and visual field index MD correlated in a significant negative manner.

CONCLUSIONS

Though patient examination was fast using the HRT II instrument, the technique with the present software cannot be considered suitable for glaucoma screening, since its sensitivity is low. The HRT II seems to be useful when added to other diagnostic techniques.

The Tehran Eye Study: research design and eye examination protocol

BACKGROUND

Visual impairment has a profound impact on society. The majority of visually impaired people live in developing countries, and since most disorders leading to visual impairment are preventable or curable, their control is a priority in these countries. Considering the complicated epidemiology of visual impairment and the wide variety of factors involved, region specific intervention strategies are required for every community. Therefore, providing appropriate data is one of the first steps in these communities, as it is in Iran. The objectives of this study are to describe the prevalence and causes of visual impairment in the population of Tehran city; the prevalence of refractive errors, lens opacity, ocular hypertension, and color blindness in this population, and also the familial aggregation of refractive errors, lens opacity, ocular hypertension, and color blindness within the study sample.

METHODS DESIGN

Through a population-based, cross-sectional study, a total of 5300 Tehran citizens will be selected from 160 clusters using a stratified cluster random sampling strategy. The eligible people will be enumerated through a door-to-door household survey in the selected clusters and will be invited. All participants will be transferred to a clinic for measurements of uncorrected, best corrected and presenting visual acuity; manifest, subjective and cycloplegic refraction; color vision test; Goldmann applanation tonometry; examination of the external eye, anterior segment, media, and fundus; and an interview about demographic characteristics and history of eye diseases, eye trauma, diabetes mellitus, high blood pressure, and ophthalmologic cares. The study design and eye examination protocol are described.

CONCLUSION

We expect that findings from the TES will show the status of visual problems and their causes in the community. This study can highlight the people who should be targeted by visual impairment prevention programs.

Intraocular pressure development after cataract surgery: a prospective study in 50 dogs (1998-2000)

OBJECTIVE

To study the course of intraocular pressure (IOP) after cataract surgery in 50 dogs.

DESIGN

Prospective study.

ANIMALS

Fifty dogs without preoperative ocular hypertension were selected for cataract surgery.

METHODS

All dogs underwent cataract surgery: 25 by manual extracapsular extraction and 25 by phacoemulsification. For each dog, intraocular pressure was measured before surgery, and 1, 3, 5, 18 h, 1 week and 1 month post surgery.

RESULTS

No significant difference of mean intraocular pressure between the two surgical methods was observed for each time measurement. Nine dogs had postoperative hypertension (IOP > 25 mmHg) during the first 5 hours post surgery. Incidence of postoperative hypertension was not significantly different with manual extracapsular extraction (16%) vs. phacoemulsification (20%). A decrease of mean IOP was observed 1 h after surgery (8.49 mmHg vs. 10.91 mmHg), then an increase 3 and 5 h post surgery (12.3 and 13.32 mmHg, respectively). At 18 h, 1 week and 1 month post surgery, mean IOP decreased. Mean IOP was 10.38, 10.38 and 8.84 mmHg, respectively.

CONCLUSION

In this study incidence of POH is not high. However, a follow-up of IOP in the first hours after cataract surgery is required to avoid complications of the retina and optic nerve and to administer hypotensive treatment if necessary.

Hypertension and the eye

In addition to being the chief cause of death in developed countries, systemic hypertension is also a leading cause of visual impairment. The eye is an end arteriolar system and is therefore susceptible to changes in blood pressure. It is also the only place where blood vessels can be clearly viewed by noninvasive techniques. This paper reviews current research into premalignant and malignant retinal signs of systemic hypertension. Previous methods of classifying retinal hypertensive signs are identified, along with more recent image analysis techniques. The need for observing the retinal vasculature as well as measuring blood pressure for monitoring systemic hypertensive patients is discussed in relation to current research.

Bias in self-reported family history and relationship to glaucoma: the Blue Mountains Eye Study

PURPOSE

To examine bias in the relationship between self-reported family history of glaucoma and its relationship to the prevalence of glaucoma and ocular hypertension.

METHODS

In a cross-sectional population-based study of 3654 Australians aged 49-97, participants were asked whether any first-degree relatives had been diagnosed with glaucoma. Open-angle glaucoma was diagnosed from matching optic disc and typical visual field changes, after gonioscopy. Ocular hypertension (OH) was diagnosed from elevated intraocular pressure (IOP) in subjects without glaucoma.

RESULTS

Glaucoma was present in 3.0% and ocular hypertension in 5.2% of subjects. A parent or sibling was reported to have glaucoma by 8.6%, including 10.5% of women and 5.9% of men. A positive family history was reported more frequently in parents (6.4%) than siblings (2.6%). Glaucoma was reported more frequently to affect mothers (5.0%) and sisters (1.6%) than fathers (1.5%) and brothers (1.2%). A first-degree family history was given by 15.7% of subjects with glaucoma compared to 8.3% of controls, odds ratio (OR) 3.2 (95% CI 1.8-5.6), after adjusting for glaucoma risk factors, including IOP. The association had a similar magnitude for a family history in parents and siblings. Although recall bias was evident from the finding of increased odds (OR 4.2) among previously diagnosed cases, the relationship with family history also persisted in newly-diagnosed cases (OR 2.4). A slightly stronger relationship was found between OH and glaucoma family history, OR 3.9 (95% CI 2.6-5.7), after adjusting for confounders, but was also strongly influenced by recall bias.

CONCLUSIONS

Although a positive family history of glaucoma may help to identify those at risk, it is subject to recall, selection and survival bias as well as community under-diagnosis of glaucoma and will most likely substantially underestimate the genetic influence.

Progression of visual field loss in untreated glaucoma patients and glaucoma suspects in St. Lucia, West Indies

PURPOSE

A 1986-1987 survey found 8.8% prevalence of open-angle glaucoma in the black population of St. Lucia, West Indies. This follow-up study assessed visual field loss progression in untreated glaucoma patients and glaucoma suspects 10 years later.

DESIGN

Cohort study.

METHODS

Subjects were 205 glaucoma patients and suspects; 1987 data included age, sex, visual acuity, and visual fields measured by automated threshold perimetry (Humphrey C 30-2 test), and 1997 data included intraocular pressure, visual acuity, and visual fields measured by the same test. Exclusion criteria included field unreliability, field improvement due to vision improvement, nonglaucomatous vision deterioration, glaucoma treatment since 1988, and scoring of a visual field as end stage in 1987. Visual fields were scored by algorithms for the Advanced Glaucoma Intervention Study (AGIS) and Collaborative Initial Glaucoma Treatment Study (CIGTS).

RESULTS

By AGIS criteria, 55% of 146 right eyes and 52% of 141 left eyes showed progression of visual field loss. In linear regressions, progression severity was unassociated with sex, intraocular pressure, or baseline visual field score, but was positively associated with age (P <.001, right; P =.002, left). The cumulative probability of reaching end stage in 10 years in at least one eye was approximately 16% by AGIS criteria. By CIGTS criteria, 73% of 146 right eyes and 72% of 141 left eyes progressed.

CONCLUSIONS

These data provide a unique opportunity to study progression of untreated glaucoma. The percentage of eyes showing visual field loss progression and the percentage reaching end stage were considerably higher than in studies of visual field progression in treated eyes.

[Eye tension and open angle glaucoma in a Burkina Faso hospital]

PURPOSE

Studying the correlation between high intraocular pressure and glaucoma in black African patients.

PATIENTS

and method: This study was retrospective and was based on 235 patients, i.e. 470 eyes examined from April 1993 to december 1998 for elevated eye pressure, at the Sanou Souro hospital of Bobo-Dioulasso, Burkina Faso. For each subject, we noted visual acuity, age, sex, ocular tonus, the result of optical disc examination with the three-mirror glass, and the visual field examined with Goldmann perimetry. We excluded infants, young children, glaucoma with normal pressure, and patients with incomplete files.

RESULTS

The patients were from 14 to 80 years old, with 18.3% 40 years-old or less. Male subjects predominated with a sex ratio of 2.26. Visual acuity was lost in 191 eyes (40.6%) and optic disk excavation was total in 214 eyes (45.5%). The Goldmann perimetry visual field test revealed defects in 390 eyes (83%). Ocular tension, optic disk excavation of the glaucomatous type, and visual field defects were associated in 70.4% of the cases.

CONCLUSION

This study shows that in 70.4% of the cases, there was a correlation between high intraocular pressure and glaucoma. This glaucoma is acute and appears in young subjects. Efforts will be made to alert our population and detect glaucoma precociously.

Cardiac and ocular manifestations in Egyptian patients with mucopolysaccharidoses

Cardiac and ocular manifestations were evaluated in 21 patients clinically suspected of mucopolysaccharidosis. After electrophoresis analysis of urinary glycoaminoglycans, 3 patients were excluded because their results did not correlate with any known type of mucopolysaccharidosis. Echocardiography revealed abnormal findings in 11 patients (61.1%). The mitral valve was the most commonly affected valve; 7 patients (38.9%) had thickened mitral valve and 6 had mitral regurge. Corneal opacities were found in 3 patients (16.7%) and progressive increase in intraocular pressure in 1 patient (5.6%), while fundus examination showed early optic atrophy in 1 patient (5.6%) and bilateral papilloedema in 2 patients (11.1%).

[Glaucoma and ocular hypertension in primary care]

OBJECTIVES

To find the distribution of intra-ocular pressure (IOP) in our population over 40 and the prevalence of glaucoma (G) and ocular hypertension (OH).

DESIGN

Descriptive.

SETTING

Primary care.

SUBJECTS

990 people >= 40 years old.Measurements. Age, sex, body mass index (BMI), ophthalmic history, risk factors, visual sharpness (optotype), ophthalmoscopy and IOP (applanation tonometry). Patients with back-of-eye disorders and/or IOP >= 21 mmHg were referred to the ophthalmologist for assessment (campimeter).

RESULTS

870 people, average age 54.66 and 45.4% of them men. Mean IOP was 12.96 in the right eye and 13.27 in the left, with significant differences between them, but not between sexes or age-groups. 70 patients were referred (11 for IOP >= 21, 54 for disturbance perceived by ophthalmoscope and 5 for both reasons). The ophthalmologist classified 9 as G, 12 as OH and 15 as suspected G. We calculated 1.81% (95% CI, 0.98-2.63) prevalence of G in the >= 40s, including 9 cases already known. OH prevalence was 1.61% (95% CI, 0.82-2.39). Through logistical regression, we found greater risk of G in people with myopia (OR adjusted for age and sex = 3.01) and Hypertriglyceridaemia (ORa, 6.34). OH risk was significantly greater in patients with BMI >= 30 (ORa, >= 4.20).

CONCLUSIONS

Glaucoma prevalence confirms published findings from other similar populations, while IOP and OH prevalence were much less here. Given that half G cases are undiagnosed, we believe its early detection in primary care should be highlighted, at least in at-risk groups.

Association of demographic, familial, medical, and ocular factors with intraocular pressure

OBJECTIVE

To describe the distribution and associations of demographic, familial, medical, and ocular factors with intraocular pressure (IOP).

METHODS

A cluster stratified random sample of urban and rural residents of Victoria, Australia, aged 40 years and older. Participants completed an interview and underwent a standardized dilated ophthalmic examination including measurement of IOP with an electronic applanation tonometer (Tono-Pen). Glaucoma status (possible, probable, definite) was determined by a consensus panel. The main outcome measure was IOP.

RESULTS

The mean age of the 4576 participants was 59 years, 53% were women, 32% were born overseas, and 132 had open-angle glaucoma. Geometric mean (SD) IOP was 14.3 (+/-1.5) mm Hg. The relationship between IOP and nuclear sclerosis, iris color, and family history of glaucoma depended on glaucoma status. In those with glaucoma, family history of glaucoma and country of birth were significantly associated with IOP in multivariate models (model: r(2) = 0.08, P =.01). In the group without glaucoma, place of residence, use of alcohol, iris color, vitamin E intake, and spherical equivalent were associated with IOP (model: r(2) = 0.01, P =.006).

CONCLUSION

In participants with glaucoma, genetic factors seem to be stronger predictors of IOP, whereas in those without glaucoma, lifestyle and physiological factors seem to play a greater role.

Patterns of open-angle glaucoma in the Barbados Family Study

OBJECTIVE

To describe the Barbados Family Study of open-angle glaucoma (OAG) and present risk factors for OAG in siblings of study probands.

DESIGN

Observational study of families of probands with OAG.

PARTICIPANTS

Two hundred thirty probands and 1056 relatives (from 207 families).

METHODS

Probands and their family members underwent standardized examinations, including automated perimetry, applanation tonometry, ophthalmologic evaluation, fundus photography, blood pressure, interview, and genotyping. Generalized estimation equation methods were used to evaluate risk factors.

MAIN OUTCOME MEASURES

Presence of OAG in the relatives, as defined by both visual field and optic disc findings, after ophthalmologic exclusion of other causes.

RESULTS

The median ages of probands and relatives were 68 and 47 years, respectively. In the 207 families, 29% of the probands had one relative with OAG and 10% had two or more relatives affected. Of the 1056 family members, 10% had OAG, 13% had suspect OAG, and 6% had ocular hypertension. One fifth of the 338 siblings had OAG (n = 67); they tended to be older and more often were male. Multivariate comparisons between siblings with and without OAG found that age, higher intraocular pressure (IOP), myopia, and lower diastolic blood pressure-IOP differences were related to OAG, whereas hypertension and diabetes were not.

CONCLUSIONS

Based on standardized protocols and examinations, approximately one quarter of the relatives had OAG or suspected OAG, despite their relatively young age. Risk factors for OAG in siblings were similar to risk factors in unrelated individuals. Analyses are ongoing to determine OAG inheritance and to localize potential gene(s) involved.

[Incidence of encapsulated bleb after filtering surgery]

OBJECTIVE

To determine the incidence of encapsulated bleb (EB) after filtering surgery, and the risk factors for the development of this complication, especially those related with the surgical procedure.

METHODS

Ninety eyes that were submitted to trabeculectomy were prospectively studied. Lens extraction was associated in 56 eyes (62.9%). All patients were followed up for at least 3 months.

RESULTS

There were clinical characteristics of encapsulation in 29 eyes (32.3%) and EB with a peak IOP of 25 mmHg or higher in 14 eyes (15.7%). The incidence of EB formation was 20.5% in men and 11.8% in women (p.044). The incidence of EB was higher in the trabeculectomy group alone (24.2%) than in the group in which it was associated to cataract surgery (10.5%) (p.003). There were clinical characteristics of encapsulation in 40.7% of primary open angle glaucoma (p.041). EB was significantly associated with an increased failure rate (21.4%) when compared to normal blebs (5.55% failure rate) (p<.001).

CONCLUSIONS

The encapsulated bleb is significantly more frequent in the male gender and thick conjunctivas and in trabeculectomy alone versus trabeculectomy associated to cataract surgery. It means a significantly greater risk of failure after surgery in the short term.