Institute for Sociology and Demography, University of Rostock, Rostock, Germany.
Institute for Sociology and Demography, University of Rostock, Rostock, Germany
BMJ Open Ophthalmol. 2022 Jan 31;7(1):e000838. doi: 10.1136/bmjophth-2021-000838. eCollection 2022.
Glaucoma is a leading cause of severe visual impairment and blindness (SVI/B) worldwide. Hence, it is of utmost importance to explore relevant risk factors and study the pace of progression to SVI/B.
We used a random sample of 250 000 persons from administrative individual-level health records of the Allgemeine Ortskrankenkassen between 2004 and 2015. We identified 3535 primary open-angle glaucoma (POAG) patients aged 55 and older and followed them for up to 10 years. Monocular and binocular SVI/B were defined by the ICD-10 classifications H54.0 and H54.4. Ophthalmological and chronic disease risk factors were analysed by applying a multivariable Cox proportional hazard model.
The risk of SVI/B in POAG patients was significantly increased by the presence of specific additional eye diseases such as secondary glaucoma (HR: 3.08, p<0.001), retinal vascular occlusion (HR: 3.00, p<0.001) or age-related macular degeneration (AMD) (HR: 2.26, p<0.001). The risk was highest in the first 2 years after the POAG diagnosis and significantly decreased after the fifth year (HR: 0.36, p=0.002). Ocular injuries, other ocular diseases, non-ophthalmological comorbidities, and age and sex had no significant influence (p>0.05).
Although progression to SVI/B is relatively rare in POAG patients in Germany, one must be aware of additional risk factors, such as secondary glaucoma, retinal vascular occlusion and AMD. Regular ophthalmological examinations help prevent the progression of SVI/B, especially in the first years after the POAG diagnosis. Specific, targeted, and timely treatments for the other eye diseases could help prevent or delay SVI/B.
青光眼是全球范围内导致严重视力损害和失明（SVI/B）的主要原因。因此，探索相关的风险因素并研究进展为 SVI/B 的速度至关重要。
我们使用了 2004 年至 2015 年期间行政个人层面健康记录中一般地区健康保险公司的随机抽样，其中包括 25 万人。我们确定了 3535 名年龄在 55 岁及以上的原发性开角型青光眼（POAG）患者，并对他们进行了长达 10 年的随访。单眼和双眼 SVI/B 通过 ICD-10 分类 H54.0 和 H54.4 定义。通过应用多变量 Cox 比例风险模型分析了眼科和慢性疾病风险因素。
POAG 患者存在特定的附加眼病，如继发性青光眼（HR：3.08，p<0.001）、视网膜血管阻塞（HR：3.00，p<0.001）或年龄相关性黄斑变性（AMD）（HR：2.26，p<0.001）等，SVI/B 的风险显著增加。在 POAG 诊断后的前 2 年内风险最高，并且在第五年后显著降低（HR：0.36，p=0.002）。眼部损伤、其他眼部疾病、非眼科合并症以及年龄和性别无显著影响（p>0.05）。
尽管德国 POAG 患者进展为 SVI/B 的情况相对较少，但必须注意继发性青光眼、视网膜血管阻塞和 AMD 等其他风险因素。定期进行眼科检查有助于预防 SVI/B 的进展，尤其是在 POAG 诊断后的最初几年。针对其他眼部疾病进行特定、有针对性和及时的治疗可能有助于预防或延迟 SVI/B。
