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Disclaimer: About 80% to 90% of this piece was written by Laurel A. Rockefeller. The other 10% to 20% was written by Arpi Haroutunian.

Laurel A. Rockefeller

Issue 2, September 17, 2004: Risk Supplement Program

Publication
An evidence-based assessment of risk factors for the progression of ocular hypertension and glaucoma. David S. Friedman, MD, MPH; M. Roy Wilson, MD, MS; Robert D Fechtner, MD; Robert N Weinreb, MD. Am J Ophthalmol. 2004;138 Supplement: S19-S31.

Discussion synopsis

• Using the findings of landmark studies and smaller, less controlled, population studies, Dr. Friedman et al synthesize the primary risk factors for ocular hypertension and glaucoma progression to help assign levels of risk in individual patients. The authors weighed the strength of the evidence in support of the reported risk factors that may be useful in assessing the risk for progression in individual patients. They concluded that only a subset of OH patients will develop glaucoma. Relying heavily on OHTS, high IOP, thinner central corneas, and age were all found to be risk factors.

  • Greater cup-to-disk ratios are sometimes considered a risk factor for glaucoma. However, it is equally likely that large cup-to-disk ratios in ocular hypertensive patients is an indicator of early structural damage and not causal in nature.

  • Black individuals have a higher incidence of thinner corneas, higher IOP, and larger cup-to-disk ratios on average than white individuals, accounting for what appears to be a racial risk factor for glaucoma.
    

  • Whereas family history puts an individual at risk for glaucoma, other risk factors play larger roles in the overall occurrence of glaucoma.
    

• Migraines, pseudoexfoliation, myopia, hyperopia, outflow facility, and male sex are suspected risk factors that need to be studied in greater detail to determine to what degree each impacts progression

• Decisions regarding implementation and extent of therapy for OH can be difficult and require an understanding of the relative importance of risk factors for progression.
  
  
  Conclusion
  The most predictive and useful indicators of progression to glaucoma are high IOP, increased cup-to-disc-ratio, thinner central corneas, and older age. Other possible risk factors still need further examination and may emerge as more important as the science evolves.
  

BACK TO HOMEPAGE

Disclaimer: About 80% to 90% of this piece was written by Laurel A. Rockefeller. The other 10% to 20% was written by Arpi Haroutunian.