Department of Ophthalmology, Basaksehir Cam ve Sakura City Hospital, University of Health Sciences, Istanbul, 34480, Turkey.
Department of Ophthalmology, Lahey Hospital & Medical Center, 1 Essex Center Drive, Peabody, MA, 01960, USA.
Eye (Lond). 2021 Dec;35(12):3350-3357. doi: 10.1038/s41433-021-01417-0. Epub 2021 Feb 3.
To compare the rate of glaucoma-related diagnoses in patients with exudative or non-exudative age-related macular degeneration (AMD).
Patients above the age of 55 with a diagnosis of AMD were identified from billing records from 2015 to 2018. Out of the 3991 patients with AMD, two cohorts with 990 patients in each were formed by randomly age-matching patients with exudative AMD with those with non-exudative AMD; patients within each group were further classified by subtype and severity of glaucoma. Charts of AMD patients without glaucoma-related diagnoses were reviewed to determine potential underdiagnosis. We applied a set of broad clinical criteria that comprised an intraocular pressure ≥22 mmHg, a cup-to-disc ratio (CDR) ≥ 0.6, and/or CDR difference between eyes of ≥0.2.
The rate of diagnosed, open-angle glaucoma was significantly lower in patients with exudative AMD (6.06%) compared to patients with non-exudative AMD (8.99%, P = 0.04). Similarly, the rate of suspected glaucoma was significantly lower in the first group compared to the second (12.12% versus 18.48%, respectively, P < 0.001). A greater number of patients with exudative AMD (13.94%, n = 138) met clinical risk criteria compared with those having non-exudative AMD (6.97%, n = 69, P < 0.001). When these at-risk patients were added to their respective groups, the rate of glaucoma, or its suspicion, became similar (χ = 1.24, P = 0.539).
A significantly lower rate of diagnosed glaucoma, or its suspicion, was identified in patients with exudative compared to non-exudative AMD. This apparent underdiagnosis was resolved by the retrospective application of clinical criteria that may represent a risk of glaucoma.
比较渗出性或非渗出性年龄相关性黄斑变性（AMD）患者的青光眼相关诊断率。
从 2015 年至 2018 年的计费记录中确定年龄在 55 岁以上的 AMD 患者。在 3991 名 AMD 患者中，通过随机年龄匹配渗出性 AMD 患者与非渗出性 AMD 患者，形成了两个各有 990 名患者的队列；在每个组内，根据青光眼的亚型和严重程度进一步进行分类。回顾无青光眼相关诊断的 AMD 患者的图表，以确定潜在的漏诊。我们应用了一套广泛的临床标准，包括眼内压≥22mmHg、杯盘比（CDR）≥0.6 和/或双眼之间的 CDR 差值≥0.2。
渗出性 AMD 患者（6.06%）确诊的开角型青光眼发生率明显低于非渗出性 AMD 患者（8.99%，P=0.04）。同样，第一组的疑似青光眼发生率也明显低于第二组（分别为 12.12%和 18.48%，P<0.001）。与非渗出性 AMD 患者（6.97%，n=69）相比，更多的渗出性 AMD 患者（13.94%，n=138）符合临床风险标准（P<0.001）。当将这些处于风险中的患者添加到各自的组中时，青光眼或其疑似诊断的发生率变得相似（χ=1.24，P=0.539）。
与非渗出性 AMD 相比，渗出性 AMD 患者的确诊青光眼或其疑似诊断率明显较低。通过回顾性应用可能代表青光眼风险的临床标准，解决了这种明显的漏诊问题。
