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Original Investigation
April 2018

Detection of Glaucoma Progression in Individuals of African Descent Compared With Those of European Descent

Author Affiliations
  • 1Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla
  • 2Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
  • 3School of Medicine, University of Alabama, Birmingham
  • 4Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
  • 5Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina
JAMA Ophthalmol. 2018;136(4):329-335. doi:10.1001/jamaophthalmol.2017.6836
Key Points

Question  Are there racial differences in visual field variability over time?

Findings  In a cohort study, individuals of African descent with glaucoma showed a larger variability in standard automated perimetry results, as well as increased times to detect progression on computer simulated analyses, compared with individuals of European descent.

Meaning  Increased visual field variability in glaucomatous eyes in individuals of African descent may result in delayed detection of progression that could potentially contribute to explain higher rates of glaucoma-related visual impairment in this population.

Abstract

Importance  Individuals of African descent have been reported to be at higher risk for becoming visually impaired from glaucoma compared with individuals of European descent.

Objective  To investigate racial differences in longitudinal visual field variability and their impact on time to detect visual field progression.

Design, Setting, and Participants  This multicenter prospective observational cohort study included 236 eyes of 173 individuals of European descent and 235 eyes of 171 individuals of African descent followed up for a mean (SD) time of 7.5 (3.4) years.

Main Outcomes and Measures  Differences in test-retest variability and simulated time to detect progression in individuals of African descent and of European descent with glaucoma. Standard automated perimetry mean deviation values were regressed over time for each eye, and SD of the residuals was used as a measure of variability. Distributions of residuals were used in computer simulations to reconstruct “real-world” standard automated perimetry mean deviation trajectories under different assumptions about rate of change and frequency of testing. Times to detect progression were obtained for the simulated visual fields.

Results  Among the 344 patients, the mean (SD) age at baseline was 60.2 (10.0) and 60.6 (9.0) years for individuals of African descent and of European descent, respectively; 94 (52%) and 86 (48%) of individuals of African descent and of European descent were women, respectively. The mean SD of the residuals was larger in eyes of individuals of African descent vs those of European descent (1.45 [0.83] dB vs 1.12 [0.48] dB; mean difference: 0.33 dB; 95% CI of the difference, 0.21-0.46; P < .001). The eyes in individuals of African descent had a larger increase in variability with worsening disease (P < .001). When simulations were performed assuming common progression scenarios, there was a delay to detect progression in eyes of individuals of African descent compared with those of European descent. For a scenario with baseline mean deviation of –10 dB and rate of change of –0.5 dB/y, detection of progression in individuals of African descent was delayed by 3.1 (95% CI, 2.9-3.2) years, when considered 80% power and annual tests.

Conclusions and Relevance  Patients of African descent with glaucoma showed increased visual field variability compared with those of European descent, resulting in delayed detection of progression that may contribute to explain higher rates of glaucoma-related visual impairment in individuals of African descent compared with those of European descent with glaucoma.

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