A long-term prospective study of risk factors for glaucomatous visual field loss in patients with ocular hypertension

Purpose: To evaluate the importance of baseline risk factors for development of glaucomatous visual field loss in patients with high-risk ocular hypertension. Methods: In the Malmo Ocular Hypertension Study, 90 patients were randomized to topical timolol or placebo treatment and observed prospectively for up to 10 years. Patients with elevated intraocular pressure (IOP) and with open angles and normal visual fields, plus at least one extra risk factor, were eligible. Risk factors were suspect disc or known disc hemorrhage, positive family history of glaucoma, pseudoexfoliation or pigment dispersion syndrome, diabetes. and mean IOP on DTC >= 27 mm Hg. These risk factors and also the mean baseline IOP and IOP fluctuation, sex, age, and blood pressure were evaluated as predictors for development of reproducible glaucomatous visual field loss. In addition to the prospective data, post-study data were retrieved from patients' records extending maximum follow-up to 17 years. Results: Thirty-seven patients developed glaucomatous visual field loss. Of all factors included in the analysis, disc appearance, older age, and higher IOP came out as significant risks. Suspect disc appearance increased the risk approximately three times, with a hazard ratio of 2.90. and CI: 1.34-6.30, the hazard ratio was 1.05 and CI: 1.03-1.09 per year of age, while mean baseline IOP increased the risk with 14% per turn Hg (CI: 1.01-1.28). . Conclusion: Patients with ocular hypertension were at higher risk for developing glaucomatous visual field loss if discs were suspect, if IOP was high, and if the patient was older in age.