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Evaluating the Impact of Uveitis on Visual Field Progression Using Large-Scale Real-World Data

To compare rates of visual field (VF) loss in uveitis patients with glaucoma against patients with primary open-angle glaucoma (POAG) and explore the association between intraocular pressure (IOP) and rate of VF loss. Retrospective cohort study. Anonymized VFs and IOP measurements extracted from the...

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Bibliographic Details
Published in:American journal of ophthalmology 2019-11, Vol.207, p.144-150
Main Authors: Liu, Xiaoxuan, Kelly, Stephen R., Montesano, Giovanni, Bryan, Susan R., Barry, Robert J., Keane, Pearse A., Denniston, Alastair K., Crabb, David P.
Format: Article
Language:English
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Summary:To compare rates of visual field (VF) loss in uveitis patients with glaucoma against patients with primary open-angle glaucoma (POAG) and explore the association between intraocular pressure (IOP) and rate of VF loss. Retrospective cohort study. Anonymized VFs and IOP measurements extracted from the electronic medical records of 5 regionally different glaucoma clinics in England. A total of 205 eyes with diagnosis of uveitis plus glaucoma were compared with 4600 eyes with POAG only. Minimum inclusion criteria were ≥4 visits within a 4-year window. Relative risk (RR) of being a “rapid progressor” (mean deviation [MD] loss ≥1.5 dB/year) was calculated. A mixed-effects model (MEM) and a pointwise VF progression analysis of pattern deviation were used to confirm differences between the groups. Longitudinal IOP mean, range, and variability were compared with rate of VF progression. Median (interquartile range) baseline MD in the uveitis and POAG groups was −3.8 (−8.7, −1.5) dB and −3.1 (−6.6, −1.2) dB, respectively. The uveitis and POAG groups had 23 of 205 (11%) and 331 of 4600 (7%) “rapidly progressing” eyes, respectively. Age-adjusted RR for “rapid progression” in uveitic vs POAG eyes was 1.9 (95% confidence interval: 1.8-2.0). The MEM confirmed that uveitic eyes (−0.49 dB/year) showed higher rates of VF progression than the POAG group (−0.37 dB/year; P < .01). IOP range and variability were higher in the “rapidly progressing” uveitic eyes. Our analysis suggests that VF loss occurs faster in glaucoma patients with uveitis than those without uveitis. The risk of progressing rapidly in glaucoma with uveitis is almost double than in those without uveitis. Early identification of “rapid progressors” may enable targeted intervention to preserve visual function in this high-risk group. •This study uses real-world data from glaucoma clinics in England to investigate whether there is a difference in the rates of visual field (VF) loss between patients with primary open-angle glaucoma (POAG) vs glaucoma plus uveitis.•We found that the uveitis plus glaucoma group had a significantly higher age-corrected rate of VF progression than the POAG group.•The age-adjusted relative risk ratio of uveitis plus glaucoma eyes for losing mean deviation ≥1.5 dB/year was 1.9 (95% confidence interval: 1.8-2.0) when compared to eyes with POAG only.•Longitudinal intraocular pressure analysis showed higher intraocular pressure range and variability, particularly in uveitic eyes that progr
ISSN:0002-9394
1879-1891
DOI:10.1016/j.ajo.2019.06.004