Evaluating the Impact of Uveitis on Visual Field Progression Using Large Scale Real-World Data.

Liu, Xiaoxuan and Kelly, Stephen R and Montesano, Giovanni and Bryan, Susan R and Barry, Robert J and Keane, Pearse A and Denniston, Alastair K and Crabb, David P (2019) Evaluating the Impact of Uveitis on Visual Field Progression Using Large Scale Real-World Data. American journal of ophthalmology. ISSN 1879-1891.

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Official URL: https://www.ajo.com/article/S0002-9394(19)30271-5/...

Abstract

PURPOSE

To compare rates of visual field (VF) loss in uveitis patients with glaucoma against patients with primary open angle glaucoma (POAG) and explores the association between intraocular pressures (IOP) and rate of VF loss. Design; Retrospective cohort study.

METHODS

Anonymized VFs and IOP measurements extracted from the EMR of 5 regionally different glaucoma clinics in England. A total of 205 eyes with diagnosis of "uveitis" plus "glaucoma" were compared with 4600 eyes with "POAG" only. Minimum inclusion criteria was ≥4 visits within a 4-year window. Relative risk (RR) of being a "rapid progressor" (mean deviation (MD) loss ≥1.5 dB/year) was calculated. A mixed-effects model (MEM) and a pointwise VF progression analysis of pattern deviation was used to confirm differences between the groups. Longitudinal IOP mean, range and variability were compared with rate of VF progression.

RESULTS

Median (IQR) baseline MD in the uveitis and POAG groups was -3.8 (-8.7, -1.5) dB and -3.1 (-6.6, -1.2) dB respectively. The uveitis and POAG groups had 23/205 (11%) and 331/4600 (7%) "rapidly progressing" eyes respectively. Age-adjusted RR for "rapid progression" in uveitic versus POAG eyes was 1.9 (95% CI:1.8-2.0). The MEM confirmed that uveitic eyes (-0.49 dB/year) showed higher rates of VF progression than the POAG group (-0.37 dB/year; p<0.01). IOP range and variability were higher in the "rapidly progressing" uveitic eyes.

CONCLUSIONS

Our analysis suggests that VF loss occurs faster in glaucoma patients with uveitis than those without uveitis. The risk of progressing rapidly in glaucoma with uveitis is almost double than in those without uveitis. Early identification of "rapid progressors" may enable targeted intervention to preserve visual function in this high-risk group.

Item Type: Article
Subjects: WW Eyes. Ophthalmology
Divisions: Ambulatory Care > Ophthalmology
Related URLs:
Depositing User: Miss Emily Johnson
Date Deposited: 05 Jul 2019 13:47
Last Modified: 05 Jul 2019 13:47
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/2211

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