Cohort Study of Race/Ethnicity and Incident Primary Open-Angle Glaucoma Characterized by Autonomously Determined Visual Field Loss Patterns

Abstract

Purpose: We evaluated racial/ethnic differences in primary open-angle glaucoma (POAG) defined by machine-learning-derived regional visual field (VF) loss patterns.

Methods: Participants (N = 209,036) from the Nurses' Health Study (NHS; 1980-2018), Nurses' Health Study II (NHS2; 1989-2019), and Health Professionals Follow-Up Study (HPFS; 1986-2018) who were ≥40 years of age and free of glaucoma were followed biennially. Incident POAG cases (n = 1946) with reproducible VF loss were confirmed with medical records. Total deviation information from the earliest reliable glaucomatous VF for each POAG eye (n = 2564) was extracted, and machine learning analyses were used to identify optimal solutions ("archetypes") for regional VF loss patterns. Each POAG eye was assigned a VF archetype based on the highest weighting coefficient. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using per-eye Cox proportional hazards models.

Results: We identified 14 archetypes: four representing advanced loss patterns, nine of early loss, and one of no VF loss. Compared to non-Hispanic whites, black participants had higher risk of early VF loss archetypes (HR = 1.98; 95% CI, 1.48-2.66) and even higher risk for advanced loss archetypes (HR = 6.17; 95% CI, 3.69-10.32; P-contrast = 0.0002); no differences were observed for Asians or Hispanic whites. Hispanic white participants had significantly higher risks of POAG with paracentral defects and advanced superior loss; black participants had significantly higher risks of all advanced loss archetypes and three early loss patterns, including paracentral defects.

Conclusions: Blacks, compared to non-Hispanic whites, had higher risks of POAG with early central and advanced VF loss.

Translational relevance: In POAG, risks of VF loss regional patterns derived from machine learning algorithms showed racial differences.

Figure 1.

The 14 archetypal visual field loss patterns (ATs) derived from visual fields of the 1957 incident primary open-angle glaucoma cases (2581 affected eyes). The integer at the top left of each archetype denotes the archetype number. The percentage at the bottom left of each archetype indicates the respective average decomposition weight for this pattern.

Figure 2.

Spearman correlation coefficients between the weight coefficients of the 14 archetypal VF loss patterns in the better (vertical axis) and worse (horizontal axis) eyes among 624 incident POAG cases who were affected in both eyes. Blue and red denote positive and negative correlations, respectively.