Glaucoma and mortality risk: findings from a prospective population-based study.

Glaucoma is a neurodegenerative disease with a structural change of the optic nerve head, leading to visual field defects and ultimately blindness. It has been proposed that glaucoma is associated with increased mortality, but previous studies had methodological limitations (selective study samples, lack of data on potential confounders, self-reported or secondary data on glaucoma diagnoses). We evaluated the association between diagnosed glaucoma and mortality in the population-based National Health and Nutrition Examination Survey (NHANES), a representative health survey in the United States. The survey cycles 2005-2006 and 2007-2008 included an extensive ophthalmic examination with fundus photography, which were used to derive standardized glaucoma diagnoses. Risk of all-cause mortality was assessed with multivariable Cox proportional hazards regression models accounting for the complex survey design of NHANES. Time to death was calculated from the examination date to date of death or December 31, 2015 whichever came first. 5385 participants (52.5% women) were eligible, of which 138 had glaucoma at baseline, and 833 died during follow-up. Participants with glaucoma were more likely to be older than those without glaucoma (mean age 69.9 vs. 56.0 years). Mean follow-up time was 8.4 years for participants with glaucoma, and 8.6 years for participants without glaucoma. Glaucoma was associated with increased mortality in an unadjusted Cox regression model (hazard ratio 2.06, 95% confidence interval 1.16 to 3.66), but the association was no longer statistically significant after adjusting for age and sex (hazard ratio 0.74, 95% confidence interval 0.46 to 1.17). Additional adjustment for a range of potential confounders did not significantly change the results. In this representative population-based study, we found no evidence of increased mortality risk in glaucoma patients.

Outcomes of Wider Area Bleb Revision Using Bleb Knife With Adjunctive Mitomycin C.

PRECIS: Wider area bleb revision using bleb knife with adjunctive mitomycin C (MMC) had a good success rate, according to strict success criteria, except in patients with neovascular glaucoma (NVG). PURPOSE: We determined the efficacy of wider area bleb revision after filtering surgery using bleb knife with adjunctive MMC. PATIENTS AND METHODS: In this retrospective single-center study, we analyzed 86 patients with glaucoma (46 primary open-angle, 18 exfoliations, 13 secondary, and 9 neovascular) after bleb revision using bleb knife with adjunctive MMC after a minimum follow-up of 6 months. A Kaplan-Meier survival analysis with log-rank tests and Cox proportional hazards regression analyses were performed. The main outcome measure was a successful initial bleb revision using bleb knife with adjunctive MMC, arbitrarily defined as intraocular pressure (IOP) control <15 mm Hg without any IOP-lowering medication, additional bleb revision, or glaucoma surgery. RESULTS: The mean time since the initial filtering surgery was 243.8 days, and the mean prebleb revision IOP was 22.0±4.8 mm Hg. The total cumulative success rate of the bleb revision using bleb knife with MMC was 49% at 6 months and 30% at 1 year. Patients with primary open-angle glaucoma had the best success rate (64% at 6 mo and 40% at 1 y). Log-rank tests revealed that patients with NVG had the worst prognosis (P<0.01). NVG was the only significant risk factor identified for short survival time (odds ratio, 167.10; 95% confidence interval, 1.78-15620.44; P=0.027). CONCLUSION: Wider area bleb revision using bleb knife with adjunctive MMC had a good success rate, according to strict success criteria, except in patients with NVG.

Is normal-tension glaucoma a risk factor for stroke?-A 10-year follow-up study.

OBJECTIVES: To investigate whether patients with normal-tension glaucoma (NTG) have a higher incidence of stroke. DESIGN: A population-based retrospective cohort study based on data from the Taiwan National Health Insurance Research Database (NHIRD) from January 1, 2001, to December 31, 2010. METHODS: Data were retrospectively collected from the NHIRD. A total of 245 (20.1%) patients with a history of stroke at the time of glaucoma diagnosis were excluded, and 1,218 patients with NTG who were 20 years of age and older were identified. Patients' age, gender and pre-existing comorbidities, including hypertension, diabetes, congestive heart failure, ischemic heart disease, atrial fibrillation and disorders of lipid metabolism, were recorded. The propensity score method with a 1:5 matching ratio was used to minimize selection bias. Cox regression with robust variance estimation was used to estimate the hazard ratio (HR) of developing stroke between the NTG and control groups. RESULTS: After adjusting for patient age, gender, and pre-existing comorbidities, the HR was 6.34, indicating that the incidence of stroke was significantly higher in patients with NTG than in controls. Furthermore, a higher risk of stroke was also found in most subgroups with the above-mentioned comorbidities. CONCLUSION: NTG is a significant risk factor for subsequent stroke in most of the described comorbidity subgroups. Early interventions for stroke prevention should be provided to newly diagnosed patients with NTG.

Long-term results of non-valved glaucoma drainage implant surgery and glaucoma drainage implant combined with trabeculectomy.

PURPOSE: The purpose was to investigate the efficacy and complications of nonvalved glaucoma drainage implant (GDI) surgery and GDI combined with trabeculectomy. SUBJECTS AND METHODS: Serial Japanese patients who received GDI were retrospectively investigated. The survival rate of eyes was analyzed using the Kaplan-Meier method, defining death as: (1) Intraocular pressure (IOP) <6 mmHg, or ≥22 mmHg, and <20% reduction of preoperative IOP, (2) additional glaucoma surgery, (3) loss of light perception. Prognostic factors of age, sex, previous surgery, type of glaucoma, synechial closure, preoperative IOP, type of GDI (single-, double-plate Molteno, Baerveldt 350) and GDI combined with trabeculectomy were investigated employing proportional hazards analysis. RESULTS: One hundred and twenty-four eyes of 109 patients aged 53.3 ± 7.8 years old were analyzed. Types of GDI were single-plate (15.3%), double-plate Molteno (71.8%), and Baerveldt 350 (12.9%). The results of survival rate analysis were 86.1, 71.1, 71.1, and 64.6% for 1, 3, 5, and 10 years respectively. Thirty-four eyes (27.4%) died because of uncontrolled IOP (19.4%), loss of light perception (5.6%), and additional glaucoma surgery (2.4%). Single-plate Molteno was the only risk factor for failure. Persistent unphysiological hypotony (0.8%) and bullous keratopathy (5.6%) were observed. CONCLUSION: Nonvalved GDI surgery and GDI combined with trabeculectomy using nonabsorbable tube ligature proved to be an excellent device for any type of glaucoma in Japanese patients. Hypotony and corneal endothelial loss are the most serious complication in the long-term results of our patients.

DBA/2J mice are susceptible to diabetic nephropathy and diabetic exacerbation of IOP elevation.

Some pathological manifestations of diabetes in the eye include retinopathy, cataracts and elevated intraocular pressure (IOP). Loss of retinal ganglion cells (RGCs) in non-proliferative stages of diabetic retinopathy and small increases in IOP in diabetic patients has raised the possibility that diabetes affects the development and progression of ocular hypertension and glaucoma. The Ins2Akita mutation is known to cause diabetes and retinopathy on a C57BL/6J (B6) background by as early as 3 months of age. Here, the impact of the Akita mutation on glaucoma was assessed using DBA/2J (D2) mice, a widely used mouse model of ocular hypertension induced glaucoma. In D2.Ins2Akita/+ mice, the contribution of diabetes to vascular permeability, IOP elevation, RGC loss, and glaucoma development was assessed. D2.Ins2Akita/+ mice developed a severe diabetic nephropathy and early mortality between 6-8 months of age. This agrees with previous reports showing that the D2 background is more susceptible to diabetes than the B6 background. In addition, D2.Ins2Akita/+ mice had vascular leakage, astrocyte reactivity and a significant increase in IOP. However no RGC loss and no anterograde axonal transport dysfunction were found at 8.5 months of age. Therefore, our data show that despite severe diabetes and an increased IOP compared to controls, RGCs do not lose axon transport or degenerate. This may be due to a DBA/2J-specific genetic modifier(s) that could provide novel and important avenues for developing new therapies for diabetic retinopathy and possibly glaucoma.

[Life expectancy of patients with primary glaucoma, residents of a large industrial city of Siberia].

PURPOSE: To investigate life expectancy and the structure of causes of death in patients with primary glaucoma, residents of a large industrial city of Siberia. MATERIAL AND METHODS: The database of the Novokuznetsk Public Health Department information analysis center on registration forms 025 (outpatients) and 066 (inpatients) for 2004-2011 was analyzed. RESULTS: A total of 5424 primary glaucoma patients were registered during 2004-2011, of whom 441 (8.1%) subsequently died. Age at death of patients with primary glaucoma was 69.0 +/- 7.2 years. The difference between age at death and at diagnosis of glaucoma was 2.6 +/- 1.8 years. CONCLUSION: The correlation suggests that primary glaucoma is a predicting factor for vascular events, such as stroke or myocardial infarction. The authors assume that topical administration of beta blockers without consulting a physician and/or a cardiologist may lead to ischemic stroke.

[Long-term surgical results of initial trabeculotomy combined with sinusotomy performed inferiorly].

PURPOSE: To evaluate retrospectively the long-term effects of initial trabeculotomy combined with sinusotomy performed inferiorly. PATIENTS AND METHOD: Enrolled were 128 eyes of 100 patients who received initial glaucoma surgery. In 36 eyes, the removal of Schlemm's canal endothelium was also performed (removed group). The results were compared with the intact group RESULTS: In the primary open angle glaucoma (POAG), mean intraocular pressure (IOP) at 3 years after surgery was 14.6 (intact) and 15.4 mmHg (removed). Kaplan-Meier life-table analysis showed that qualified success rates for the intact group at 8 years were 62.2% and for the removed group at 5 years 45.2% defined by 20 mmHg or lower. The results in developmental glaucoma (DG) were similar to those in POAG. No statistical differences in postoperative IOP between the intact and removed groups were seen in either POAG or DG. In exfoliation glaucoma (XFG), mean IOPs for the intact group at 3 years were 17.3 mmHg and for the removed group at 2 years 15.4 mmHg. The success rates for the intact group at 3.5 years were 25.2% and for the removed group at 4.5 years 64.3%. The results in the intact group were worse than in the POAG patients. Although visual disturbance was seen in 13% of the patients, the major cause was the progression of the cataracts. CONCLUSIONS: The long-term results were the same as those of previous reports on surgery performed superiorly, including the frequency of visual disturbance. However the removal of Schlemm's canal endothelium is necessary in XFG for better IOP control.

Association between the use of glaucoma medications and mortality.

OBJECTIVE: To evaluate the relationship between glaucoma medication use and death. METHODS: This study uses longitudinal data from 2003 to 2007 on persons 40 years and older with glaucoma or suspected glaucoma enrolled in a large managed care network. Cox regression analysis was performed to estimate the hazard of death associated with the use of various glaucoma medication classes and combinations thereof. Multivariable models were adjusted for demographic characteristics and comorbid medical conditions. RESULTS: Of 21 506 participants with glaucoma or suspected glaucoma, 237 (1.1%) died during the study period. The use of any class of glaucoma medication was associated with a 74% reduced hazard of death (adjusted hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.16-0.40) compared with no glaucoma medication use. This association was observed for use of a single agent alone, such as a topical beta-antagonist (0.44; 0.24-0.83) or a prostaglandin analogue (0.31; 0.18-0.54), and for use of different combinations of drug classes. CONCLUSIONS: After adjustment for potential confounding variables, the use of glaucoma medications was associated with a reduced likelihood of death in this large sample of US adults with glaucoma. Future investigations should explore this association further because these findings may have important clinical implications.

Topical beta-blockers and mortality.

PURPOSE: To study the associations between long-term and short-term use of topical beta-blockers and mortality. DESIGN: Prospective population-based cohort study. PARTICIPANTS: To examine long-term effects, 3842 participants aged 55 years and older were recruited. To examine short-term effects, 484 incident beta-blocker users and 4700 age-matched controls were recruited. All participants were recruited as part of the Rotterdam Study. METHODS: To examine long-term effects, associations between topical beta-blocker use before and at baseline, between 1990 and 1997, and mortality between 1997 and 2005 were studied. Data were analyzed using Cox regression, and hazard ratios were adjusted for age, gender, smoking, systemic hypertension, diabetes mellitus, and angina pectoris. Short-term effects were defined as death within 3 months after the first prescription of a topical beta-blocker. Mortality was compared between incident beta-blocker users, that is, participants who started using a topical beta-blocker between the onset of the Rotterdam Study in 1990 and October 1, 2004, and age-matched controls. Short-term effects were examined using a chi-square test. Confounding by smoking was analyzed by stratification. MAIN OUTCOME MEASURES: For long-term effects, hazard ratios of topical beta-blocker use for all-cause mortality and cardiovascular mortality; for short-term effects, chi-square statistics between mortality of incident topical beta-blocker users and age-matched controls. RESULTS: With regard to long-term effects, mean age at baseline was 72 years (standard deviation, 7 years). Topical beta-blockers were used by 228 participants. Seven hundred nine participants died during the follow-up (18%); 135 (3.5%) died of a cardiovascular cause. The hazard ratio of topical beta-blocker use was 0.94 (95% confidence interval [CI], 0.71-1.25; P = 0.69) for all-cause mortality and 1.02 (95% CI, 0.56-1.86; P = 0.95) for cardiovascular mortality. With regard to short-term effects, 4 (0.8%) of the 484 incident topical beta-blocker users died within 3 months after their first prescription; 65 (1.4%; P = 0.31) of the 4700 aged-matched controls died within a similar period. CONCLUSIONS: Use of topical beta-blockers seems not to be associated with excess mortality.

Analysis of glaucoma-related mortality in the United States using death certificate data.

PURPOSE: Recent studies have reported a connection between glaucoma and decreased survival. To evaluate the underlying causes of glaucoma-related mortality, we searched vital records data for deaths citing glaucoma and reviewed the demographic variables and comorbidities contained on these records. MATERIALS AND METHODS: Deaths including glaucoma, as either an underlying cause or a contributing cause of death, were selected from US multiple-cause-of-death data for the years 1990 to 2003 and combined with population data from the US Census Bureau to calculate mortality rates. Logistic regression was used to determine whether reporting of accidents and/or selected systemic disorders are associated with glaucoma on the death certificate. RESULTS: Fifteen thousand two hundred twenty-eight glaucoma-related deaths (0.05%) were identified during the years under study. Black males had the highest glaucoma-related mortality rate with 9.4 deaths per 1,000,000 persons annually, whereas Hispanic females had the lowest mortality rate at 1.8 deaths per 1,000,000. After adjusting for age, sex, and race/ethnicity, positive associations were found between glaucoma and hypertension [Odds ratio (OR): 4.89; 95% confidence interval (CI)=4.73-5.05], diabetes (OR: 2.60; 95% CI=2.50-2.71), asthma (OR: 3.14; 95% CI=2.72-3.62), and accidents of all types (OR: 1.45; 95% CI=1.35-1.55). CONCLUSIONS: Glaucoma is an important contributor to mortality for certain individuals. The disparities in mortality rates observed among race/ethnic strata may be attributed to differences in access to care as well as true differences in disease incidence and/or severity among racial groups. Despite limitations with the data, our findings suggest associations between glaucoma and a number of comorbid conditions. These associations should be explored in future studies and serve to guide strategies for disease management and prevention.

Age-related eye disease, visual impairment, and survival: the Beaver Dam Eye Study.

OBJECTIVE: To investigate the relationship of age-related maculopathy, cataract, glaucoma, visual impairment, and diabetic retinopathy to survival during a 14-year period. METHODS: Persons ranging in age from 43 to 84 years in the period from September 15, 1987, to May 4, 1988, participated in the baseline examination of the population-based Beaver Dam Eye Study (n = 4926). Standardized protocols, including photography, were used to determine the presence of ocular disease. Survival was followed using standardized protocols. RESULTS: As of December 31, 2002, 32% of the baseline population had died (median follow-up, 13.2 years). After adjusting for age, sex, and systemic and lifestyle factors, poorer survival was associated with cortical cataract (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.06-1.37), any cataract (HR, 1.16; 95% CI, 1.03-1.32), diabetic retinopathy (HR per 1-step increase in 4-level severity, 1.36; 95% CI, 1.14-1.63), and visual impairment (HR, 1.24; 95% CI, 1.04-1.48) and marginally associated with increasing severity of nuclear sclerosis (HR, 1.07; 95% CI, 0.99-1.16). Age-related maculopathy and glaucoma were not associated with poorer survival. Associations tended to be slightly stronger in men than women. CONCLUSIONS: Cataract, diabetic retinopathy, and visual impairment were associated with poorer survival and not explained by traditional risk factors for mortality. These ocular conditions may serve as markers for mortality in the general population.

[Clinical results of fornix-based trabeculectomy with a scleral tunnel].

PURPOSE: To evaluate retrospectivery the efficacy and safety of fornix-based trabeculectomy with a scleral tunnel. PATIENTS AND METHODS: We studied the records of 204 eyes of 156 patients who underwent fornix-based trabeculectomy with mitomycin C as their primary surgery between 2000 and 2002 and had a follow-up period of 6 months or more. A 3.5 or 4 mm rectangular double scleral flap incision was made and a scleral tunnel was fashioned by removing the second flap to allow the aqueous to flow into the fornix side. RESULTS: The mean intraocular pressure was significantly decreased from 22.2 +/- 7.8 (mean +/- standard deviation) mmHg to 12.4 +/- 3.9 mmHg 2 years after surgery (p < 0.0001). When the target pressure was defined as 15 mmHg, the 2-year survival rate using the Kaplan-Meier survival analysis was 69.1 %. Early wound leakages occurred in 16 eyes (7.8%) and additional sutures were needed on 13 eyes. The visual acuity of 22 eyes (11.0%) decreased by at least 2 lines. CONCLUSION: Although there are some complications specific to trabeculectomy, fornix-based trabeculectomy with a scleral tunnel appears to be an effective method of decreasing intraocular pressure.

Glaucoma and mortality.

PURPOSE: To compare mortality rates in glaucoma patients and matched controls from a large population screening as well as glaucoma patients diagnosed through routine clinical examination (self-selected patients). METHODS: A population-based screening of 32,918 elderly citizens of Malmö was conducted between 1992 and 1997. Individuals with newly detected, previously untreated open-angle glaucoma were identified. Two controls of the same age and gender were chosen among the screening negative participants for each patient. From the same birth cohorts, glaucoma patients seen in routine clinical practice (self-selected patients) were identified through retrospective examination of patient records from the Eye Department at Malmö University Hospital. The number and time of deaths for each group were determined based on centrally administered registers. RESULTS: Mean follow-up time was 7.75 years. Five-year mortality did not differ significantly between the groups, and was 9.2% among glaucoma patients from the screening (n=402), and 11.9% among the controls (n=804; p=0.7406). Self-selected glaucoma patients had a 5-year mortality of 8.5% (n=354), not significantly different from the screening-detected glaucoma patients (p=0.1361). Among glaucoma patients, neither IOP (p=0.1781) nor pseudoexfoliation (p=0.8882) was related to significantly increased mortality. CONCLUSIONS: The results of this study strongly suggest that the life expectancy of glaucoma patients does not differ from the population at large.

Glaucoma and survival: the National Health Interview Survey 1986-1994.

OBJECTIVE: Associations between glaucoma and survival have not been studied extensively, in part, because of the relatively low prevalence of this condition. This study examines associations between self-reported glaucoma and mortality in a nationally representative sample of U.S. adults. DESIGN: Annual cross-sectional multistage area probability survey of the U.S. civilian noninstitutionalized population living at addressed dwellings. PARTICIPANTS: Mortality linkage with >96% of participants from the 1986 to 1994 National Health Interview Survey was performed by the National Center for Health Statistics through 1997. Complete data were available on 116796 adults >or=018 years old. METHODS: Adults within randomly selected households were administered a chronic conditions list that included questions about glaucoma and visual impairment. Proxy information on these conditions was obtained when household members were unavailable for interview. Statistical methods included Cox regression models with adjustments for covariates, as well as for the complex sample survey design. MAIN OUTCOME MEASURE: All-cause mortality and cardiovascular and cancer mortality. RESULTS: A total of 1559 (1.3%) glaucoma cases were reported. Nearly 19% of participants with reported glaucoma also had reported visual impairment (n = 303). Mortality linkage identified 8949 deaths; the average follow-up was 7.0 years. After controlling for survey design, gender, age, race, marital status, education level, and self-rated health, participants with reported glaucoma but without reported visual impairment were at significantly increased risk of death relative to participants without reported glaucoma, irrespective of visual impairment status (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.19-1.53); similar associations were found for participants with reported glaucoma and visual impairment vs. participants with no reported glaucoma (HR, 1.39; 95% CI, 1.14-1.71). An increased risk of cardiovascular disease mortality was found for participants with reported glaucoma both without (HR, 1.31; 95% CI, 1.11-1.55) and with (HR, 1.53; 95% CI, 1.15-2.05) reported visual impairment. Risk of mortality due to cancer was increased only in participants with reported glaucoma but without reported visual impairment (HR, 1.57; 95% CI, 1.25-1.98); this association was stronger when the mortality analysis was restricted to cancers amenable to early screening, including breast, cervical, colon, and prostate cancer (HR, 1.99; 95% CI, 1.41-2.81). CONCLUSIONS: Among adults residing in the United States, reported glaucoma is associated with an increased risk of all-cause and cardiovascular disease mortality. Associations between glaucoma and cancer were inconsistent and may reflect, in part, a detection bias, in which glaucoma is more likely to be diagnosed in adults receiving health care because of other medical conditions.

High intraocular pressure and survival: the Framingham Studies.

PURPOSE: To examine whether high intraocular pressure (greater than or equal to 25 mm Hg) or a history of treatment for glaucoma is associated with decreased survival and, if so, how such ocular markers might be explained. METHODS: Eye examinations, including applanation tonometry, were conducted on members of the Framingham Eye Study cohort from February 1, 1973, to February 1, 1975. Participants who reported a history of treatment for glaucoma were identified. Survival data, including information on the date of death, were available from the time of the Eye Study through March 31, 1990. RESULTS: Of the 1,764 persons under the age of 70 years at the baseline eye examination, 1,421 persons had low intraocular pressure (< or =20 mm Hg), 264 persons had medium intraocular pressure levels (20 to 24 mm Hg), and 79 persons had high intraocular pressure (> or =25 mm Hg) or history of glaucoma treatment. During the follow-up period, 29%, 30%, and 47% died in the groups with low, medium, and high intraocular pressure (or history of glaucoma treatment), respectively. In an age-and-sex adjusted Cox proportional hazards analysis, the death rate ratio for the group with medium intraocular pressure relative to the group with low intraocular pressure was 1.04. The corresponding death rate ratio for the group with high intraocular pressure was 1.56 with a 95% confidence interval of 1.11 to 2.19 (P < .001). After adjustment for age, sex, hypertension, diabetes, cigarette smoking, and body mass index, a positive relationship remained, but at a borderline level of significance (P = .075). CONCLUSIONS: High intraocular pressure or the presence of glaucoma is a marker for decreased life expectancy in the Framingham Eye Study cohort. The relationship is present even after adjustment for risk factors known to be associated with higher mortality such as age, sex, hypertension, diabetes, cigarette smoking, and body mass index. Special attention to the general health status of patients with high intraocular pressure or glaucoma seems warranted.

Age-related eye disease and survival. The Beaver Dam Eye Study.

OBJECTIVE: To investigate the relationship of cataract, age-related maculopathy, glaucoma, and visual impairment to survival in the population-based Beaver Dam Eye Study. DESIGN: In this population-based study, visual acuity was measured with use of standardized protocols. At baseline, stereoscopic color fundus photographs and color slit-lamp and retroillumination photographs were graded in a masked fashion to determine the presence of age-related maculopathy and cataract, respectively. Deaths were ascertained by contacting family members, daily review of obituaries, and use of vital status records. PARTICIPANTS: Subjects aged 43 through 84 years who lived in Beaver Dam, Wis, were identified and examined between 1988 and 1990. RESULTS: From the time of the baseline examination until a median of 4 years later, 9.5% (467/4926) of the population had died. After correcting for age and sex, poorer survival was associated with more severe nuclear sclerosis (5-year survival of 88.9% for the most severe compared with 94.1% for the least severe stage) and visual impairment (5-year survival of 87.5% for impaired compared with 91.8% for unimpaired vision). However, after controlling for systemic factors, only more severe nuclear sclerosis in people without diabetes was significantly associated with poorer survival (hazard ratio per level of severity, 1.19; 95% confidence interval, 1.00 to 1.40). CONCLUSIONS: These data suggest that after controlling for age and sex, nuclear sclerotic cataract severity, cataract surgery, and visual impairment are risk indicators for poorer survival. Cortical cataract, posterior subcapsular cataract, glaucoma, and age-related maculopathy were unrelated to poorer survival.

Survival of elderly ophthalmic out-patients.

Elderly ophthalmic out-patients that had visited an eye-clinic were searched in a population register 7 years later. Observed numbers of survivors were compared with those expected according to appropriate life tables. Most observed numbers of survivors came close to the expected ones. Patients, aged more than 80 years when visiting the eye-clinic, had, however, a consistently increased survival rate. Glaucoma patients, less than 80 years old, had a slightly (not significantly) lower survival rate than expected.