Severity of Glaucoma at First Presentation to Hospital Eye Services

Context/Background: To identify the proportion of patients with glaucoma presenting to hospital eye services with advanced disease and determine risk factors for late presentation. Methods: A retrospective study was conducted including100 consecutive patients newly referred from community optometrists to the glaucoma clinic at the Princess Alexandra Eye Pavilion, Edinburgh, Scotland. All subjects underwent slit lamp examination, intraocular pressure (IOP), central corneal thickness (CCT), fundus examination and standard automated perimetry (SAP). 84 patients with glaucoma were categorised according to SAP mean deviation (MD) in the worse eye as ‘late presenters’ if MD was ≤ -6dB; and ‘very late presenters’ if MD was ≤ -10dB.Logistic regression analysis identified factors associated with late presentation. Results: Mean age was 73.2 ± 10.2 years. 36 patients (42.9%) were female and 28 (33.3%) had a family history of glaucoma. 41 of 84 (48.8%) had an MD in the worse eye ≤ -6dB and 23 of 84 (27.4%) had an MD in the worse eye ≤ -10dB. Older age (p = 0.004) was a significant risk factor for late presentation. Gender (p = 0.660), IOP (p = 0.712), CCT (p = 0.968), and family history (p = 0.108) were not associated with late presentation. Conclusions: Half of patients presenting to hospital eye services for the first time with newly diagnosed glaucoma had a MD ≤ -6dB in at least one eye. Older patients were more likely to present with advanced disease. Increasing awareness of glaucoma in the elderly population may allow earlier diagnosis and reduce vision related morbidity. Keywords: Glaucoma; Risk factors; Visual fields; Late presentation; Ag