Comparison of Primary Open-Angle Glaucoma and Exfoliation Glaucoma at Diagnosis

Abstract

Purpose

To compare ocular findings in eyes with primary open-angle glaucoma (POAG) and exfoliation glaucoma (EG) at the time of diagnosis when identical diagnostic criteria for glaucoma were applied.

Methods

We conducted a study on records of 519 consecutive, unselected patients with chronic glaucoma filing for cost-free medication from the Finnish National Social Insurance Institute (FSII). Fourteen cases were excluded for having other types of glaucoma. The documents were provided by eye hospitals or by licensed ophthalmologists. The criteria for glaucoma were set by the Parliament of Finland and applied by FSII. A total of 329 patients had POAG and 176 had EG. The main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), cup-to-disc ratio of the optic nerve head (C/D), and glaucomatous changes of the visual fields (VF).

Results

As regards sex, the 2 groups were comparable: 66% female with POAG and 68% with EG. The EG patients were older (mean ± SD 74 ± 8.6 years) vs POAG (68 ± 11.4 years). The EG eyes had slightly lower BCVA. The POAG eyes had mean intraocular pressure (IOP) 24 ± 5.4 mm Hg. A total of 12% in this group had highest IOP of less than 18 mm Hg (low-tension glaucoma [LTG]) but there were none of EG. All EG eyes had a mean IOP 28.3 ± 9.3 mm Hg. Among EG patients, 26% had unilateral disease, with a mean IOP of 33.7 ± 8.7 mm Hg, while the opposite eyes had a mean of 19 ± 3 mm Hg. There was not much difference in the C/D ratios of POAG and EG eyes and the VF profiles were similar.

Conclusions

At diagnosis, patients with EG were older than those with POAG and had higher mean IOP values. Among patients with POAG, there were 12% with LTG, but none among EG. A total of 26% among EG had unilateral disease with marked IOP asymmetry. The C/D and VF profiles were similar because the patients had been seen early in the disease course. Early recognition and lifelong most effective therapy of EG are strongly advocated.

Keywords

Exfoliation glaucoma Exfoliation syndrome Glaucoma Primary open-angle glaucoma Pseudoexfoliation

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References

Tarkkanen

Reunanen

Kivelä

Frequency of systemic vascular diseases in patients with primary open-angle glaucoma and exfoliation glaucoma. Acta Ophthalmol 2008; 86: 598–602

Jonasson

Damji

Arnarsson

Prevalence of open-angle glaucoma in Iceland: Reykjavik Eye Study. Eye 2003; 17: 747–53

Musch

Gillespie

Niziol

Cashwell

Lichter

Collaborative Initial Glaucoma Treatment Study Group. Factors associated with intraocular pressure before and during 9 years of treatment in the Collaborative Initial Glaucoma Treatment Study. Ophthalmology 2008; 115: 927–33

Konstas

AGP

Mantziris

Stewaret

Diurnal intraocular pressure in untreated exfoliation and primary open-angle glaucoma. Arch Ophthalmol 1997; 115: 182–5

Heijl

Bengtsson

Hyman

Leske

Early Manifest Glaucoma Trial Group. Natural history of open-angle glaucoma. Ophthalmology 2009; 116: 2271–6

Futa

Shimizu

Furuyoshi

Nishiyama

Hagihara

Clinical features of capsular glaucoma in comparison with primary open-angle glaucoma in Japan. Acta Ophthalmol 1992; 70: 214–9

Schlötzer-Schrehardt

Naumann

GOH

Ocular and systemic pseudoexfoliation syndrome. Am J Ophthalmol 2006; 141: 921–37

Aulhorn

Harms

Early visual field defects in glaucoma. In: Leydhecker

ed. Glaucoma (Tützing Symposium) Basel

Karger

1967151–86

Tarkkanen

Pseudoexfoliation of the lens capsule: a clinical study of 418 patients with special reference to glaucoma, cataract and the changes of the vitreous. Acta Ophthalmol Scand 1962Suppl 711–98

10.

Klemetti

Intraocular pressure in exfoliation syndrome. Acta Ophthalmol Suppl 1988; 184 Suppl 18454–8

11.

Arnarsson

Damji

Sverrisson

Sasaki

Jonasson

Pseudoexfoliation in the Reykjavik Eye Study: prevalence and related ophthalmological variables. Acta Ophthalmol Scand 2007; 85: 822–7

12.

Johnson

Fan

Camras

Toris

Aqueous humor dynamics in exfoliation syndrome. Arch Ophthalmol 2008; 126: 914–20

13.

Hitchings

Low tension glaucoma: its place in modern glaucoma practice. Br J Ophthalmol 1992; 76: 494–6

14.

Kivelä

Hietanen

Uusitalo

Autopsy analysis of clinically unilateral exfoliation syndrome. Invest Ophthalmol Vis Sci 1997; 38: 2008–15

15.

Puska

Unilateral exfoliation syndrome: conversion to bilateral exfoliation and to glaucoma: a prospective 10-year follow-up study. J Glaucoma 2002; 11: 517–24

16.

Ritch

Schlötzer-Schrehardt

Konstas

AGP

Why is glaucoma associated with unilateral exfoliation?

Prog Retin Eye Res 2003; 22: 253–75

17.

Vesti

Kivelä

Exfoliation syndrome and exfoliation glaucoma. Prog Retin Eye Res 2000; 19: 345–68

18.

Ritch

Schlötzer-Schrehardt

Exfoliation syndrome. Surv Ophthalmol 2001; 45: 265–315

19.

Hollo

Konstas

AGP

Exfoliation Syndrome and Exfoliative Glaucoma, 2 ed.

Savona, Italy

European Glaucoma Society

2012