Risk factors for late presentation in chronic glaucoma

PURPOSE. To identify the risk factors for having advanced glaucomatous visu al field loss on the first visit at three hospital eye services. METHODS. This was a hospital-based! case-control study involving patients n ewly diagnosed with glaucoma at first visit to one of three ophthalmic depa rtments in the United Kingdom. Patients with a previous history of ocular h ypertension or any documented suspicion of glaucoma (within the hospital ey e service) were excluded. RESULTS, Occupational group, initial intraocular pressure (IOP), family his tory of glaucoma, method of referral to hospital, and the number of years s ince the last visit to an optometrist were found to be independently associ ated with late presentation. A linear trend of increasing odds of late atte ndance was associated with increasing Standard Occupational Classification. Those in managerial (category II) and skilled (category III) groups estima ted (95% confidence intervals) to be, respectively, 0.2 (0.00, 0.16) and 0. 27 (0.1, 0.8) as likely to attend with advanced glaucomatous field loss as unskilled (category V) people with similar initial IOP, family history, ref erral route, and time since last optometrist visit. The data strongly sugge st an association between IOP and advanced field loss at initial hospital e xamination. There was a 1.2 (1.121 1.28) increase in the OR of late present ation per unit increase in millimeters of mercury after adjustment for the other mentioned factors. People with a family history of glaucoma were esti mated to be almost one third (adjusted OR, 0.29 [0.12, 0.74]) as likely to have advanced field loss as those with no family history. People referred b y any source other than an optometrist who has made the correct diagnosis o f glaucoma mere 4.5 times (adjusted OR, 4.53 [152, 13.48]) more likely to b e late attenders than patients so referred but similar in other mentioned f actors. These data also provide strong evidence that the more years since t he last visit to an optometrist, the greater the likelihood of having advan ced glaucomatous visual field loss on the first visit to the eye service (a djusted OR per year, 1.25 [1.10, 1.42]). CONCLUSIONS. These data strongly suggest that certain subgroups of people w ith glaucoma were at greater risk of having advanced and irremediable field loss on first visiting the eye services studied.