It is important that glaucoma patients at risk of end-of-life visual impairment should be identified and treated accordingly

The Science behind the Tip

The ultimate outcome measure of glaucoma treatment is visual impairment and blindness at the time of death. Based on a systematic review we found the occurrence of end-of-life visual impairment to be considerable in glaucoma patients (1). The reported figures for end-of-life visual impairment are 9%, 9.2% and 15%, for unilateral blindness 11% and 24.1% and for bilateral blindness 0%, 2.7%, 9% and 10.6% (2-6).

Factors associated with end-of-life visual impairment in glaucoma are more advanced baseline visual field loss, higher base-line intraocular pressure, older age and longer duration of disease1. These factors have also been shown to correlate with progression of visual field loss in glaucoma. Older patients that present with advanced glaucomatous damage and high IOP should be considered to be at risk of blindness and treated accordingly.

Contributor: C A Webers, Holland

References

1. Ernest PJ, Schouten JS, Beckers HJ et al. An evidence based review of prognostic factors for glaucomatous visual field progression. Ophthalmology 2013; 120:512-19
2. Forsman E, Kivela T, Vesti E. Lifetime visual disability in open-angle glaucoma and ocular hypertension. J Glaucoma 2007; 16 (3) 313-19
3. Ang GS, Eke T. Lifetime visual prognosis for patients with primary open-angle glaucoma. Eye 2007; 21:604-08.
4. Goh YW, Ang GS, Azura-Blanco A. Lifetime visual prognosis with glaucoma. Clin Exp Ophthalmol 2011; 39:766-70.
5. Ernest PJG, Busch MJWM, Webers CA. Prevalence of end-of-life visual impairment in patients followed for glaucoma. Acta Ophthalmol 2013; 91 (8): 738-43.
6. Peters D, Bengtsson B, Heijl A. Lifetime risk of blindness in open-angle glaucoma. Am J Ophthalmol. 2013;156:724-30.

Tip Reviewer: Roger Hitchings
Tip Editors: John Salmon and Gordana Sunaric Mégevand