Risk factors for late presentation in chronic glaucoma

Abstract

Purpose: To identify the risk factors for having advanced glaucomatous visual field loss on the first visit at three hospital eye services.

Methods: This was a hospital-based, case-control study involving patients newly diagnosed with glaucoma at first visit to one of three ophthalmic departments in the United Kingdom. Patients with a previous history of ocular hypertension or any documented suspicion of glaucoma (within the hospital eye service) were excluded.

Results: Occupational group, initial intraocular pressure (IOP), family history of glaucoma, method of referral to hospital, and the number of years since the last visit to an optometrist were found to be independently associated with late presentation. A linear trend of increasing odds of late attendance was associated with increasing Standard Occupational Classification. Those in managerial (category II) and skilled (category III) groups estimated (95% confidence intervals) to be, respectively. 0.2 (0.00, 0.16) and 0.27 (0.1, 0.8) as likely to attend with advanced glaucomatous field loss as unskilled (category V) people with similar initial IOP, family history, referral route, and time since last optometrist visit. The data strongly suggest an association between IOP and advanced field loss at initial hospital examination. There was a 1.2 (1.12, 1.28) increase in the OR of late presentation per unit increase in millimeters of mercury after adjustment for the other mentioned factors. People with a family history of glaucoma were estimated to be almost one third (adjusted OR, 0.29 [0.12, 0.74]) as likely to have advanced field loss as those with no family history. People referred by any source other than an optometrist who has made the correct diagnosis of glaucoma were 4.5 times (adjusted OR, 4.53 [1.52, 13.48]) more likely to be late attenders than patients so referred but similar in other mentioned factors. These data also provide strong evidence that the more years since the last visit to an optometrist, the greater the likelihood of having advanced glaucomatous visual field loss on the first visit to the eye service (adjusted OR per year, 1.25 [1.10, 1.42]).

Conclusions: These data strongly suggest that certain subgroups of people with glaucoma were at greater risk of having advanced and irremediable field loss on first visiting the eye services studied.