Visual Outcomes and Risk Factors for Progression in Juvenile Open-Angle Glaucoma.

Abstract

Purpose: To report the visual outcomes of patients diagnosed with juvenile open-angle glaucoma (JOAG) at presentation and final follow-up and to analyze the rate of visual impairment progression and associated risk factors.

Design: A retrospective clinical cohort study.

Participants: This retrospective study included all patients diagnosed with JOAG over 13 years from 2 tertiary hospitals in Bangkok, Thailand, with a minimum follow-up of 1 year.

Methods: We categorized visual impairment and blindness according to the World Health Organization criteria at both the initial presentation and the final follow-up visit. Progression was defined as a shift to a more severe category of visual impairment in each eye; we identified the risk factors associated with visual impairment progression.

Main outcome measures: The proportions of visual impairment and blindness at the beginning and end of the study period. The progression rates of visual impairments were calculated at 1, 3, and 5 years.

Results: We included a total of 203 eyes from 106 patients in this study. At the initial assessment, 31.5% of eyes were blind, and this percentage significantly increased to 35.5% (P < 0.001) after an average follow-up of nearly 8 years. Bilateral blindness in patients rose from 15.2% to 19.8% (P < 0.001) over the same period. Among patients without visual impairment at presentation, 96.3%, 93.1%, and 87.7% maintained stable vision at 1, 3, and 5 years, respectively. In comparison, patients with moderate visual impairment had stable outcomes in 84.6%, 67.7%, and 67.7% of cases at the same time points. However, the progression rates of visual outcomes did not significantly differ across varying visual impairment categories (P = 0.08). A higher number of glaucoma surgeries per patient was identified as an associated factor for visual impairment progression (adjusted hazard ratio = 2.25; 95% confidence interval: 1.34-3.78, P = 0.002).

Conclusions: Juvenile open-angle glaucoma is associated with severe visual impairment both at initial presentation and after treatment. Despite slow progression, more than 10% of patients experienced worsening vision over 5 years, with the number of glaucoma surgeries being a significant associated factor for progression. Lifelong follow-up and early detection are crucial in reducing morbidity in this patient group.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.