Product information and disease description Place of product in therapy Disease description

Natural history, survival, and mortality

13 evidence topics · 13 sources

Conversion from ocular hypertension to primary open-angle glaucoma: Ocular Hypertension Treatment Study, 5-year results

“During the course of the study, the mean +/- SD reduction in IOP in the medication group was 22.5% +/- 9.9%. The IOP declined by 4.0% +/- 11.6% in the observation group. At 60 months, the cumulative probability of developing POAG was 4.4% in the medication group and 9.5% in the observation group (hazard ratio, 0.40; 95% confidence interval, 0.27-0.59; P<.0001).” (opens the source at this quote in a new tab)

Conversion from ocular hypertension to primary open-angle glaucoma: Ocular Hypertension Treatment Study, 20-year results

“The 20-year cumulative incidence of POAG was 55.2% (95% CI, 47.9%-61.5%) among Black/African American participants and 42.7% (95% CI, 38.9%-46.3%) among participants of other races. The 20-year cumulative incidence for visual field loss was 25.2% (95% CI, 22.5%-27.8%). Using a 5-factor baseline model, the cumulative incidence of POAG among participants in the low-, medium-, and high-risk tertiles was 31.7% (95% CI, 26.4%-36.6%), 47.6% (95% CI, 41.6%-53.0%), and 59.8% (95% CI, 53.1%-65.5%), respectively.” (opens the source at this quote in a new tab)

Progression of untreated and treated early glaucoma: Early Manifest Glaucoma Trial

“After a median follow-up period of 6 years (range, 51-102 months), retention was excellent, with only 6 patients lost to follow-up for reasons other than death. On average, treatment reduced the IOP by 5.1 mm Hg or 25%, a reduction maintained throughout follow-up. Progression was less frequent in the treatment group (58/129; 45%) than in controls (78/126; 62%) (P =.007) and occurred significantly later in treated patients.” (opens the source at this quote in a new tab)

“After 6 years, 53% of patients progressed. In multivariate analyses, progression risk was halved by treatment (HR = 0.50; 95% CI, 0.35-0.71).” (opens the source at this quote in a new tab)
“Progression risk decreased by about 10% with each millimeter of mercury of IOP reduction from baseline to the first follow-up visit (HR = 0.90 per millimeter of mercury decrease; 95% CI, 0.86-0.94).” (opens the source at this quote in a new tab)

Lifetime risk of blindness in treated open-angle glaucoma: Sweden

“Five hundred and ninety-two patients were included. At the time of the last visit 250 patients (42.2%) had at least 1 blind eye because of glaucoma, while 97 patients (16.4%) were bilaterally blind, and 12 patients (0.5%) had low vision. Median time with a glaucoma diagnosis was 12 years (<1-29), median age when developing bilateral blindness was 86 years, and median duration of bilateral blindness was 2 years (<1-13). The cumulative incidences of blindness in at least 1 eye and bilateral blindness from glaucoma were 26.5% and 5.5%, respectively, after 10 years, and 38.1% and 13.5% at 20 years.” (opens the source at this quote in a new tab)

Probability of blindness in treated open-angle glaucoma: Olmsted County, Minnesota

“Probability of glaucoma-related blindness in at least one eye at 20 years decreased from 25.8 % (95% Confidence interval [CI]: 18.5–32.5) for subjects diagnosed in 1965–1980, to 13.5% (95% CI: 8.8–17.9) for subjects diagnosed in 1981–2000 (P=0.01).” (opens the source at this quote in a new tab)
“However, a significant proportion of patients still progress to blindness despite recent diagnostic and therapeutic advancements.” (opens the source at this quote in a new tab)

“At 20-years' follow-up, the Kaplan-Meier cumulative probability of glaucoma-related blindness in at least one eye was estimated to be 27% (95% confidence interval, 20%-33%), and for both eyes, it was estimated to be 9% (95% confidence interval, 5%-14%).” (opens the source at this quote in a new tab)

Global blindness and vision impairment attributable to glaucoma

“Globally, in 2020, 3.61 million people were blind and nearly 4.14 million were visually impaired by glaucoma. Glaucoma accounted for 8.39% (95% uncertainty intervals [UIs]: 6.54, 10.29) of all blindness and 1.41% (95% UI: 1.10, 1.75) of all MSVI. Regionally, the highest proportion of blindness relating to glaucoma was found in high-income countries (26.12% [95% UI: 20.72, 32.09]), while the region with the highest age-standardized prevalence of glaucoma-related blindness and MSVI was Sub-Saharan Africa.” (opens the source at this quote in a new tab)

“The leading global causes of blindness in those aged 50 years and older in 2020 were cataract (15·2 million cases [9% IU 12·7-18·0]), followed by glaucoma (3·6 million cases [2·8-4·4]), undercorrected refractive error (2·3 million cases [1·8-2·8]), age-related macular degeneration (1·8 million cases [1·3-2·4]), and diabetic retinopathy (0·86 million cases [0·59-1·23]).” (opens the source at this quote in a new tab)

Disease severity at detection: population screening

“Among the screened subjects, who were 77.5% of all invited subjects, a total of 406 subjects (1.23%) were identified with previously undetected glaucoma.” (opens the source at this quote in a new tab)
“Most eyes had early (35%) or moderate (31%) glaucomatous visual field defects, but 134 subjects (33%) had advanced visual field loss in at least one eye. No subject was blind in both eyes, but 3.4% of the newly diagnosed patients were unilaterally blind due to glaucoma.” (opens the source at this quote in a new tab)

Mortality: systematic review and meta-analysis of prospective studies

“Seven articles were included. The pooled ACM of POAG was 3.42% (95% confidence interval [CI] 1.70%-5.58%). The mortality rate of POAG was reported in one study as 6.1 (95% CI 5.5-6.7) per 1000 person-years. A significant association between POAG and mortality was observed in the pooled unadjusted relative mortality risk estimates (HR 2.14, 95% CI 1.32-3.47). Fully adjusted relative mortality risk estimates did not show a significant association with mortality (HR 1.13, 95% CI 0.91-1.40).” (opens the source at this quote in a new tab)

Follow-up duration and form of the first glaucoma endpoint in the Ocular Hypertension Treatment Study

“The median duration of follow-up was 72 months for African American participants and 78 months for other participants. Of the expected follow-up visits, 90% were completed during the study, and the visit completion rate did not differ by randomization group.” (opens the source at this quote in a new tab)
“Approximately 55% (69 of 125) of the initial POAG endpoints involved optic disc deterioration in the absence of visual field abnormalities meeting study criteria for a visual field endpoint.” (opens the source at this quote in a new tab)

Probability of blindness over 20 years of follow-up

“The rate of blindness from glaucoma in one or both eyes over 20 years of follow-up is approximately 13%.” (opens the source at this quote in a new tab)

Vision impairment and blindness after 14 years in the Early Manifest Glaucoma Trial

“The number of analyzed subjects was 128 in the treatment group and 123 in the initially untreated control group.” (opens the source at this quote in a new tab)
“The mean age at baseline was nearly identical in both study arms, but the mean age at study end was 1 year higher and mean follow-up time was more than 1 year longer in the control group (14.8 years) than in the treatment group (13.7 years)” (opens the source at this quote in a new tab)
“This was true both for VI in at least one eye and bilateral impairment 19.5% vs 18.7% and 4.7% vs 3.3%, respectively, as well as for unilateral and bilateral blindness, 12.5% vs 7.3% and 3.1% vs 2.4%, respectively.” (opens the source at this quote in a new tab)
“More than half of the subjects died during the study period: 68 (53%) in the treated group and 65 (53%) in the control group.” (opens the source at this quote in a new tab)

Derivation and evidence base of the pooled annual cumulative mortality estimate

“Cumulative mortality was defined as the number of deaths during the follow-up period over the total glaucoma individuals at baseline.” (opens the source at this quote in a new tab)
“Random-effects meta-analysis was conducted on the remaining four articles with available follow-up period.” (opens the source at this quote in a new tab)
“The included articles did not cover the regions of Africa and the Eastern Mediterranean, with the majority concentrated in high-income countries or regions (71.4%).” (opens the source at this quote in a new tab)

Effect of comorbidity adjustment on the association between glaucoma and mortality

“Another article based on data from Finnish social insurance found a cumulative mortality of 17.2% for POAG in Finland from June 2004 to January 2013” (opens the source at this quote in a new tab)
“This difference may be partly explained by adjustment for comorbidities and differences in covariate selection across studies.” (opens the source at this quote in a new tab)
“Given the impact of these comorbidities on mortality, we speculate that the observed association may be influenced by underlying health status and comorbidity burden rather than glaucoma itself” (opens the source at this quote in a new tab)