Elsevier

Ophthalmology

Volume 117, Issue 9, September 2010, Pages 1705-1712
Ophthalmology

Original article
Incidence of Glaucomatous Visual Field Loss: A Ten-Year Follow-up from the Rotterdam Study

Presented at: the Association for Research in Vision and Ophthalmology 2009 Annual Meeting, May 2009, Fort Lauderdale, Florida.
https://doi.org/10.1016/j.ophtha.2010.01.034Get rights and content

Purpose

To determine the 10-year incidence of glaucomatous visual field loss (GVFL) and to investigate the influence of risk factors for open-angle glaucoma on this incidence.

Design

Population-based cohort study.

Participants

Participants aged ≥55 years from the Rotterdam Study.

Methods

Of the 7983 participants in the Rotterdam Study, 6806 underwent ophthalmic examinations at baseline (1990–1993). In 6723 of these 6806 participants (99%), both visual field screening and an assessment of the optic disc were performed. After exclusion of 93 participants with GVFL at baseline, 6630 participants at risk of developing GVFL remained. These participants underwent similar ophthalmic examinations during 2 follow-up visits (1997–1999 and 2002–2006). The incidence of GVFL was determined as an incidence rate and recalculated to a 10-year risk. Risk factors for open-angle glaucoma (age, gender, positive family history of glaucoma, baseline intraocular pressure (IOP), myopia, and baseline vertical cup-to-disc ratio [VCDR]) were assessed using Cox regression. The dependent variable was the development of GVFL.

Main Outcome Measures

Ten-year risk and incidence rates of GVFL. Hazard ratios of the above-mentioned risk factors.

Results

Of 6630 participants, 3939 (59%) completed at least 1 follow-up examination and 2571 (39%) completed both; 108 participants developed GVFL. The overall incidence rate and 10-year risk of GVFL were 2.9 per 1000 person-years (95% confidence interval [CI], 2.4–3.5) and 2.8% (2.3–3.4), respectively. The 10-year risk increased from 1.9% at age 55 to 59 years to 6.4% at age ≥80 years (P<0.001). The incidence increased by 11% per millimeter of mercury increase in IOP (hazard ratio 1.11; 95% CI, 1.06–1.15). Male gender (1.62; 1.10–2.38), high myopia (spherical equivalent ≤−4 D myopic; 2.31; 1.19–4.49), and a baseline VCDR above the 97.5th percentile (4.64; 2.72–7.91) were associated with the development of GVFL. A positive family history was only significantly associated with the development of GVFL if IOP was removed from the model (2.0; 1.2–3.3; P = 0.012).

Conclusions

These data provide an estimate of the incidence of GVFL in a white population. The development of GVFL was related to higher IOP, older age, high myopia, male gender, a positive family history of glaucoma, and a larger baseline VCDR.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Study Population

The present study is part of the Rotterdam Study, a prospective population-based cohort study aimed at studying the occurrence of and risk factors for chronic diseases in the elderly. Its objectives, methods, and major findings have been described.22 The medical ethics committee of the Erasmus University approved the study protocol, and all participants provided written informed consent in accordance with the Declaration of Helsinki. After the baseline examinations between 1990 and 1993,

Results

The mean time was 6.5 years (range 5.0–9.4 years) between baseline and the first follow-up and 11.1 years (range 7.9–13.9 years) between baseline and the second follow-up. Figure 1 shows the course over time of the 6630 participants at risk of iGVFL; 3939 of 6630 participants (59%) completed at least 1 follow-up examination; 2571 participants (39%) completed both follow-up examinations. The mean follow-up time was 9.8 years (range 5.0–13.9 years).

Table 1 shows the baseline characteristics of

Discussion

Our longitudinal study with long-term follow-up shows that the 10-year risk of GVFL in a general elderly white population is highly dependent on age. The 10-year risk increases from approximately 2% in the sixth decade to approximately 6% in the highest age category. The incidence is significantly associated with higher baseline IOP, high myopia, male gender, a positive family history of glaucoma, and GON at baseline.

Open-angle glaucoma was defined in the Rotterdam Study, and in most other

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    Manuscript no. 2009-720.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Financial support: The Netherlands Organization for Health Research and Development (ZonMw) grant 2200.0035, The Hague; Lijf en Leven, Krimpen a/d Lek; MD Fonds, Utrecht. Oogfonds Nederland, Utrecht; MD Fonds, Utrecht; Stichting Nederlands Oogheelkundig Onderzoek, Nijmegen/Rotterdam; Swart van Essen, Rotterdam; Netherlands Organisation for Scientific Research, The Hague; Bevordering van Volkskracht, Rotterdam; Blindenhulp, The Hague; Landelijke Stichting voor Blinden en Slechtzienden, Utrecht; Rotterdamse Vereniging voor Blindenbelangen, Rotterdam; OOG, The Hague; Algemene Nederlandse Vereniging ter Voorkoming van Blindheid, Doorn; Laméris Ootech BV, Nieuwegein; Medical Workshop BV, Groningen; Topcon Europe BV, Capelle aan de IJssel, all in the Netherlands, and Heidelberg Engineering, Dossenheim, Germany. The sponsors or funding organizations had no role in the design, conduct, analysis or publication of this research.

    This population-based prospective study estimates the 10-year incidence of glaucomatous visual field loss in a general elderly white population to be approximately 3%.

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