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2. Risk Factors for the Progression of Open-angle Glaucoma

Balwantray C. Chauhan, PhD; Frederick S. Mikelberg, MD; A. Gordon Balaszi, MD; Raymond P. LeBlanc, CM, MD; Mark R. Lesk, MSc, MD; Graham E. Trope, MB, PhD; for the Canadian Glaucoma Study Group

Arch Ophthalmol. 2008;126(8):1030-1036.

Objective  To determine systemic and ocular risk factors for visual field progression in open-angle glaucoma.

Methods  In the Canadian Glaucoma Study, a multicenter prospective longitudinal study of 258 patients (131 men and 127 women; median age, 65.0 years), baseline systemic measures included assessment of peripheral vasospasm and markers for hematopathology, coagulopathy, and immunopathology. Patients were followed up at 4-month intervals with perimetry, optic disc imaging, and a standardized interventional protocol for intraocular pressure control. Univariate and proportional hazards models were used to identify factors that predicted progression.

Main Outcome Measure  Visual field progression with standard automated perimetry.

Results  Median follow-up was 5.3 years, with 167 patients (64.7%) completing 5 years or more and 67 patients (26.0%) completing 7 years or more. Abnormal baseline anticardiolipin antibody levels (hazard ratio [HR], 3.86; 95% confidence interval [CI], 1.60-9.31), higher baseline age (HR per year, 1.04; 95% CI, 1.01-1.07), female sex (HR, 1.94; 95% CI, 1.09-3.46), and higher mean follow-up intraocular pressure (HR per 1 mm Hg, 1.19; 95% CI, 1.05-1.36) before progression were associated with progression.

Conclusions  The Canadian Glaucoma Study identified 4 independent predictive factors for glaucomatous field progression.

Application to Clinical Practice  While confirming the importance of intraocular pressure in glaucoma progression, this study determined other risk factors that merit awareness.

Trial Registration  clinicaltrials.gov Identifier: NCT00262626

Author Affiliations: Departments of Ophthalmology and Visual Sciences, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia (Drs Chauhan and LeBlanc), and University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia (Dr Mikelberg); Departments of Ophthalmology, McGill University, Royal Victoria Hospital, Montreal, Quebec (Dr Balaszi), and Université de Montréal (Dr Lesk); and Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario (Dr Trope) Canada.

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