Chan et al identified risk factors for rapid progression in a patient with glaucoma. The authors are from the University of Sydney, Personal Eyes, Westmead Institute and Save Sight Institute in Sydney, Australia.
Patient selection: glaucoma
Outcome: rapid progression
Rapid progression was defined as a decline in mean deviation >= 1 dB per year in the Humphrey visual field test. This is associated with progression to advanced disease within 10-15 years.
Risk factors for rapid progression:
(1) cardiovascular disease
(2) hypotension
(3) pseudoexfoliation
(4) disc hemorrhages
(5) lower central corneal thickness (CCT)
Patients with cardiovascular disease tended to have lower intraocular pressures. A vascular theory for glaucoma suggests that decreased ocular perfusion pressure affects ganglion cells at the optic nerve head.
A patient with rapid progression is more likely to have medication changes and/or intra-ocular pressure lowering surgery.
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