title: Risk Factors Associated with Progression to Blindness from Primary Open-Angle Glaucoma in an African-American Population.
abstract: To determine the risk factors associated with progression to blindness from primary open-angle glaucoma (POAG) in an African-American population.
  
  
  
  This study examined 2119 patients enrolled in the Primary Open-Angle African-American Glaucoma Genetics (POAAGG) study. A total of 59 eyes were identified as legally blind as a result of POAG (cases) and were age-and sex-matched to 59 non-blind eyes with glaucoma (controls). Chart reviews were performed to record known and suspected risk factors.
  
  
  
  Cases were diagnosed with POAG at an earlier age than controls (p = 0.005). Of the 59 eyes of cases, 16 eyes (27.1%) presented with blindness at diagnosis. Cases had worse visual acuity (VA) at diagnosis (p < 0.0001), with VA worse than 20/40 conferring a 27 times higher risk of progression to blindness (p = 0.0005). Blind eyes also demonstrated more visual field defects (p = 0.01), higher pre-treatment intraocular pressure (IOP; p < 0.0001), and higher cup-to-disc ratio (p = 0.006) at diagnosis. IOP was less controlled in cases, and those with IOP ≥21 mmHg at more than 20% of follow-up visits were 73 times more likely to become blind (p < 0.0001). Cases missed a greater number of appointments per year (p = 0.003) and had non-adherence issues noted in their charts more often than controls (p = 0.03). However, other compliance data did not significantly differ between groups.
  
  
  
  Access to care, initial VA worse than 20/40, and poor control of IOP were the major risk factors associated with blindness from POAG. Future studies should examine earlier, more effective approaches to glaucoma screening as well as the role of genetics in these significantly younger patients who progress to blindness.
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Pleet
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Sulewski
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Salowe
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Raymond
authors.initials: R
authors.lastname: Fertig
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Salinas
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Rhodes
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: William
authors.initials: W
authors.lastname: Merritt Iii
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Vikas
authors.initials: V
authors.lastname: Natesh
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Jiayan
authors.initials: J
authors.lastname: Huang
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Harini V
authors.initials: HV
authors.lastname: Gudiseva
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Collins
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Venkata Ramana Murthy
authors.initials: VR
authors.lastname: Chavali
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Tapino
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Lehman
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Regina-Gigiliotti
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Eydie
authors.initials: E
authors.lastname: Miller-Ellis
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Prithvi
authors.initials: P
authors.lastname: Sankar
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Gui-Shuang
authors.initials: GS
authors.lastname: Ying
authors.affiliation: a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Joan M
authors.initials: JM
authors.lastname: O'Brien
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000453:epidemiology* / Q000208:ethnology*; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D005902:Glaucoma, Open-Angle / Q000453:epidemiology* / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014792:Visual Acuity
keywords: African; African-Americans; blindness; glaucoma; minority research; primary open-angle glaucoma