Glaucoma Characteristics and Risk Factors - Results from Malmö Eye Survey

Sammanfattning: This thesis is based on data from a large glaucoma screening, comprising 32, 918 elderly citizens of Malmö and data from retrospective analysis of glaucoma patients’ charts from the Eye Department of Malmö University Hospital. The definition of glaucoma was based on reproducible visual field defects and/or glaucomatous optic nerve head damage in both groups. In paper I, including screened individuals only, we found that the prevalence of glaucoma was strikingly dependent on refraction and markedly over-represented in myopic eyes, thus confirming myopia as an important risk factor for glaucoma. A new and interesting finding was that the relationship between glaucoma and myopia was stronger in eyes with low intraocular pressure (IOP), weaker in the group with intermediate pressure readings, and disappeared in eyes with higher pressures. In paper II, based on screening participants, we found a significant association between the use of platelet aggregation inhibitors and optic disc hemorrhages (ODH) and a non-significant tendency towards an overrepresentation of ODH in individuals who were taking anti-hypertensive medication and cholesterol-lowering agents. This could indicate an association between optic disc hemorrhages and generalized vascular disease, alternatively that individuals on platelet aggregation inhibitors are predisposed to optic disc hemorrhages, or at least prolonged or more recurrent episodes of such hemorrhages. In paper III, we compared the glaucoma patients identified through screening with self-selected patients from the Eye Department of Malmö University Hospital. Normal-tension glaucoma (NTG) was much more commonly found through population screening as compared to routine clinical examinations and mean IOP was significantly lower in patients identified through screening than in self-selected patients. Pseudoexfoliation and bilateral disease was, on the other hand, more common in the self-selected group. Visual field damage in the self-selected patients was significantly greater than in patients detected through population screening, but both groups had considerable mean visual field defects. Paper IV compares mortality in glaucoma patients and controls from the screening as well as in the glaucoma patients diagnosed at the Eye Department. The results of this study strongly suggest that the life expectancy of glaucoma patients is the same as that of normal controls. Initiation of treatment did not appear to affect the survival curves of previously untreated patients.