Dataset Information

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.

SUBMITTER: Kang JH

PROVIDER: S-EPMC9339699 | biostudies-literature | 2022 Jul

REPOSITORIES: biostudies-literature

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Publications

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

Kang Jae H JH Wang Mengyu M Frueh Lisa L Rosner Bernard B Wiggs Janey L JL Elze Tobias T Pasquale Louis R LR

Translational vision science & technology 20220701 7

<h4>Purpose</h4>We evaluated racial/ethnic differences in primary open-angle glaucoma (POAG) defined by machine-learning-derived regional visual field (VF) loss patterns.<h4>Methods</h4>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 co ...[more]

PMID: 35877093

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Project description:BackgroundPrimary angle-closure glaucoma is a type of glaucoma associated with a physically obstructed anterior chamber angle. Obstruction of the anterior chamber angle blocks drainage of fluids (aqueous humor) within the eye and may raise intraocular pressure (IOP). Elevated IOP is associated with glaucomatous optic nerve damage and visual field loss. Laser peripheral iridotomy (often just called 'iridotomy') is a procedure to eliminate pupillary block by allowing aqueous humor to pass directly from the posterior to anterior chamber through use of a laser to create a hole in the iris. It is commonly used to treat patients with primary angle-closure glaucoma, patients with primary angle closure (narrow angles and no signs of glaucomatous optic neuropathy), and patients who are primary angle-closure suspects (patients with reversible obstruction). The effectiveness of iridotomy on slowing progression of visual field loss, however, is uncertain.ObjectivesTo assess the effects of iridotomy compared with no iridotomy for primary angle-closure glaucoma, primary angle closure, and primary angle-closure suspects.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 9) which contains the Cochrane Eyes and Vision Trials Register; MEDLINE Ovid; Embase Ovid; PubMed; LILACS; ClinicalTrials.gov; and the ICTRP. The date of the search was 18 October 2017.Selection criteriaRandomized or quasi-randomized controlled trials that compared iridotomy to no iridotomy in primary angle-closure suspects, patients with primary angle closure, or patients with primary angle-closure glaucoma in one or both eyes were eligible.Data collection and analysisTwo authors worked independently to extract data on study characteristics, outcomes for the review, and risk of bias in the included studies. We resolved differences through discussion.Main resultsWe identified two trials (2502 eyes of 1251 participants) that compared iridotomy to no iridotomy. Both trials recruited primary angle suspects from Asia and randomized one eye of each participant to iridotomy and the other to no iridotomy. Because the full trial reports are not yet available for both trials, no data are available to assess the effectiveness of iridotomy on slowing progression of visual field loss, change in IOP, need for additional surgeries, number of medications needed to control IOP, mean change in best-corrected visual acuity, and quality of life. Based on currently reported data, one trial showed evidence that iridotomy increases angle width at 18 months (by 12.70°, 95% confidence interval (CI) 12.06° to 13.34°, involving 1550 eyes, moderate-certainty evidence) and may be associated with IOP spikes at one hour after treatment (risk ratio 24.00 (95% CI 7.60 to 75.83), involving 1468 eyes, low-certainty evidence). The risk of bias of the two studies was overall unclear due to lack of availability of a full trial report.Authors' conclusionsThe available studies that directly compared iridotomy to no iridotomy have not yet published full trial reports. At present, we cannot draw reliable conclusions based on randomized controlled trials as to whether iridotomy slows progression of visual field loss at one year compared to no iridotomy. Full publication of the results from the studies may clarify the benefits of iridotomy.

Dataset Information

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

Purpose

Methods

Results

Conclusions

Translational relevance

Publications

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

Similar Datasets

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