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Clinical Trials |

Canadian Glaucoma Study 2. Risk Factors for the Progression of Open-angle Glaucoma

Balwantray C. Chauhan, PhD; Frederick S. Mikelberg, MD; A. Gordon Balaszi, MD; Raymond P. LeBlanc, CM, MD; Mark R. Lesk, MSc, MD; Graham E. Trope, MB, PhD ; Canadian Glaucoma Study Group
Arch Ophthalmol. 2008;126(8):1030-1036. doi:10.1001/archopht.126.8.1030.
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Objective  To determine systemic and ocular risk factors for visual field progression in open-angle glaucoma.

Methods  In the Canadian Glaucoma Study, a multicenter prospective longitudinal study of 258 patients (131 men and 127 women; median age, 65.0 years), baseline systemic measures included assessment of peripheral vasospasm and markers for hematopathology, coagulopathy, and immunopathology. Patients were followed up at 4-month intervals with perimetry, optic disc imaging, and a standardized interventional protocol for intraocular pressure control. Univariate and proportional hazards models were used to identify factors that predicted progression.

Main Outcome Measure  Visual field progression with standard automated perimetry.

Results  Median follow-up was 5.3 years, with 167 patients (64.7%) completing 5 years or more and 67 patients (26.0%) completing 7 years or more. Abnormal baseline anticardiolipin antibody levels (hazard ratio [HR], 3.86; 95% confidence interval [CI], 1.60-9.31), higher baseline age (HR per year, 1.04; 95% CI, 1.01-1.07), female sex (HR, 1.94; 95% CI, 1.09-3.46), and higher mean follow-up intraocular pressure (HR per 1 mm Hg, 1.19; 95% CI, 1.05-1.36) before progression were associated with progression.

Conclusions  The Canadian Glaucoma Study identified 4 independent predictive factors for glaucomatous field progression.

Application to Clinical Practice  While confirming the importance of intraocular pressure in glaucoma progression, this study determined other risk factors that merit awareness.

Trial Registration  clinicaltrials.gov Identifier: NCT00262626

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Figure 1.

Frequency distribution of mean intraocular pressure (IOP) during follow-up. Data obtained after confirmed progression (if applicable) were excluded.

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Figure 2.

Cumulative survival of patients divided into equal thirds based on the mean intraocular pressure in the follow-up. Patients with mean values in the highest tertile had higher cumulative progression than those in the lowest tertile (P= .03, log-rank test). Of the 258 patients, 249 (96.5%) had sufficient observations to compute a mean intraocular pressure during follow-up. The number of patients at risk for progression in the 3 groups at the different follow-up intervals is shown below the x-axis.

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Figure 3.

Cumulative survival in men and women. Although women had a higher cumulative progression rate, the sex difference was not statistically significant in a univariate analysis (P = .17, log-rank test), but was significant in the proportional hazards model. The number of men and women at risk for progression at the different follow-up intervals is shown below the x-axis.

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