Knowing the risk factors can help in planning treatment of glaucoma patients
High IOP, advanced age, disc haemorrhage, and a history of disease progression, are the
main factors predictive of progression in patients with, glaucoma. However, many factors
that figure strongly in glaucoma onset appear to have no influence on disease
progression, said Anders Heijl MD, Skåne University Hospital Malmö, Malmö, Sweden.
“Knowledge about the risk factors for glaucoma progression is important because when
we have risk factors than we probably also need lower target intraocular pressure. And
more importantly, patients with risk factors need to be followed more frequently than
patients without risk factors for progression,” Dr Heijl told the 11
Society Congress in Nice.
He noted that several large randomised trials, including the Early Manifest Glaucoma
treatment study (EMGT) and the Advanced Glaucoma Intervention Study (AGIS) have
shown a clear association between elevated IOP and disease progression. However,
there is no evidence that broad IOP fluctuation is an independent risk factor for glaucoma
progression.
Evidence is also weak at best for any association between glaucoma progression and
central corneal thickness, refractive error, and ocular perfusion pressure, although there
is good evidence for all those factors and glaucoma onset.
Meanwhile, the studies show that advanced age doubles the risk of progression and that
disc haemorrhage increases the risk 26fold. A history of progression is also a good
predictor of future progression.
He added that, apart from adhering to their IOP lowering regimen, there unfortunately
doesn’t appear to be a lot that glaucoma patients themselves can do to reduce their risk
of glaucoma progression, Dr Heijl said.
“There is no evidence that any lifestyle factors influence the risk of glaucoma progression.
There is also a lot of talk about general health. For example, Cardiovascular disease,
blood pressure, and diabetes are often discussed and there's a lot of publications in
support of that view, but there's really no clearcut scientific evidence,” he added.
END