Characteristics of predictors for the development of end-stage primary open-angle glaucoma

PURPOSE. To study the clinical and demographic characteristics of patients with end-stage primary open-angle glaucoma (POAG).

METHODS. The study included 159 patients (318 eyes) with a median age of 72.2 years (64.7; 79.7), with end-stage POAG in one eye. All patients underwent a comprehensive ophthalmologic examination, with a thorough review of medical history and records. Data were processed by a single investigator with subsequent selective verification.

RESULTS. More than 50 clinical and demographic characteristics of patients with end-stage POAG were analyzed, focusing on four key factors: age, duration of follow-up, stage at the time of diagnosis, intraocular pressure (IOP), and history of incisional surgery. The IOP values significantly exceeded the target values, averaging 23 mm Hg (18; 32), indicating a need for more aggressive treatment. The mean disease duration before reaching the end stage of POAG was 3.9 years (0.7; 7.5). The progression of POAG was markedly asymmetric: patients with early-stage disease progressed to the end stage in 7 years (4; 12); those with moderate-stage disease progressed in 7.9 years (4; 11.9); and those with advanced-stage disease progressed in 4 years (2.2; 5.9). Regular monitoring (at least four times a year) was associated with a more than twofold delay in disease progression. The duration of disease ("up to" or "more than" 5 years) and previous surgical treatment ("yes" or "no") had an equal impact on disease development and its progression to the end stage, indicating that rather than the fact of surgery itself, the most crucial is the timing of surgery. Surgical intervention in patients with advanced stages of glaucoma, when followed up for more than 2 years (0.65; 4.6), was insufficiently effective, suggesting the need for earlier surgical intervention.

CONCLUSION. Aiming to facilitate a personalized approach to treatment, we created a risk assessment algorithm for the development of end-stage POAG for use in clinical practice.

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