Long-term structural and functional outcomes of therapy in juvenile-onset primary open-angle glaucoma: a five-year follow-up.

OBJECTIVE: To evaluate long-term structural and functional changes of the optic nerve head in medically and surgically treated juvenile-onset primary open-angle glaucoma (JOAG). METHODS: Forty-two eyes of 42 consecutive primary JOAG patients presenting between January 2000 and January 2003. Results were analysed for long-term intra-ocular pressure (IOP) control, IOP fluctuation, disc characteristics on a Heidelberg Retinal Tomograph II and for visual field changes over a 5-year period. The parameters were compared between medically and surgically treated eyes. RESULTS: The average age of the patients was 26.8 ± 6.1 years. The average baseline IOP was 35.3 ± 14.9 mm Hg. An IOP control <18 mm Hg was achieved in 84% of eyes that underwent filtering surgery (n = 17), compared to 63% on medical therapy alone (n = 25) at the end of 5 years; log rank test p = 0.38. Over 5 years, 4 eyes showed progression (9.5%) of which 3 had been medically treated and 1 had failed surgery (p = 0.45). CONCLUSION: A tenth of JOAG eyes showed progression over 5 years, and this was more common in those treated medically. Aggressive IOP lowering may thus be needed in eyes with JOAG.

Effect of glaucoma on the quality of life of young patients.

PURPOSE: To evaluate the quality of life (QOL) of juvenile-onset primary open-angle glaucoma (JOAG) patients by using a utility-based assessment. METHODS: QOL using time-tradeoff utility values was analyzed in 70 JOAG patients and compared with 108 adult-onset POAG patients. The relationships of utility values to parameters like age at diagnosis, visual acuity, mean deviation, number of medications and surgery, duration of the disease, level of education, and socioeconomic status were assessed. RESULTS: The mean age at diagnosis of JOAG patients was 26 ± 9.8 years, whereas that of the adult onset POAG patients was 62 ± 11.2 years. Overall, there was a decrease in utility values with increasing age (r = -0.3; P < 0.001). The mean utility score among JOAG patients was (0.80 ± 0.18) significantly greater than among adult POAG patients (0.64 ± 0.28; P < 0.001). The differences in utility scores between JOAG and adult POAG patients were significant when adjusted for differences in better eye visual acuity, mean deviation, and the presence of systemic comorbidity among adults (P = 0.02). Among JOAG patients, those needing topical antiglaucoma medications and those with visual acuity worse than 6/12 in the better eye had lower utility values (P = 0.008 and P = 0.002, respectively). CONCLUSIONS: Utility values among glaucoma patients in the juvenile age group are better than those of adult POAG patients. Decreasing vision in the better eye and having to use medication decrease the utility scores among young patients with glaucoma.