Carolina P B Gracitelli1,2, Linda M Zangwill1, Alberto Diniz-Filho1, Ricardo Y Abe1, Christopher A Girkin3, Robert N Weinreb1, Jeffrey M Liebmann4, Felipe A Medeiros1,5. 1. Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla. 2. Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil. 3. School of Medicine, University of Alabama, Birmingham. 4. Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York. 5. Duke Eye Center, Department of Ophthalmology, Duke University, Durham, North Carolina.
Abstract
Importance: Individuals of African descent have been reported to be at higher risk for becoming visually impaired from glaucoma compared with individuals of European descent. Objective: To investigate racial differences in longitudinal visual field variability and their impact on time to detect visual field progression. Design, Setting, and Participants: This multicenter prospective observational cohort study included 236 eyes of 173 individuals of European descent and 235 eyes of 171 individuals of African descent followed up for a mean (SD) time of 7.5 (3.4) years. Main Outcomes and Measures: Differences in test-retest variability and simulated time to detect progression in individuals of African descent and of European descent with glaucoma. Standard automated perimetry mean deviation values were regressed over time for each eye, and SD of the residuals was used as a measure of variability. Distributions of residuals were used in computer simulations to reconstruct "real-world" standard automated perimetry mean deviation trajectories under different assumptions about rate of change and frequency of testing. Times to detect progression were obtained for the simulated visual fields. Results: Among the 344 patients, the mean (SD) age at baseline was 60.2 (10.0) and 60.6 (9.0) years for individuals of African descent and of European descent, respectively; 94 (52%) and 86 (48%) of individuals of African descent and of European descent were women, respectively. The mean SD of the residuals was larger in eyes of individuals of African descent vs those of European descent (1.45 [0.83] dB vs 1.12 [0.48] dB; mean difference: 0.33 dB; 95% CI of the difference, 0.21-0.46; P < .001). The eyes in individuals of African descent had a larger increase in variability with worsening disease (P < .001). When simulations were performed assuming common progression scenarios, there was a delay to detect progression in eyes of individuals of African descent compared with those of European descent. For a scenario with baseline mean deviation of -10 dB and rate of change of -0.5 dB/y, detection of progression in individuals of African descent was delayed by 3.1 (95% CI, 2.9-3.2) years, when considered 80% power and annual tests. Conclusions and Relevance: Patients of African descent with glaucoma showed increased visual field variability compared with those of European descent, resulting in delayed detection of progression that may contribute to explain higher rates of glaucoma-related visual impairment in individuals of African descent compared with those of European descent with glaucoma.
Importance: Individuals of African descent have been reported to be at higher risk for becoming visually impaired from glaucoma compared with individuals of European descent. Objective: To investigate racial differences in longitudinal visual field variability and their impact on time to detect visual field progression. Design, Setting, and Participants: This multicenter prospective observational cohort study included 236 eyes of 173 individuals of European descent and 235 eyes of 171 individuals of African descent followed up for a mean (SD) time of 7.5 (3.4) years. Main Outcomes and Measures: Differences in test-retest variability and simulated time to detect progression in individuals of African descent and of European descent with glaucoma. Standard automated perimetry mean deviation values were regressed over time for each eye, and SD of the residuals was used as a measure of variability. Distributions of residuals were used in computer simulations to reconstruct "real-world" standard automated perimetry mean deviation trajectories under different assumptions about rate of change and frequency of testing. Times to detect progression were obtained for the simulated visual fields. Results: Among the 344 patients, the mean (SD) age at baseline was 60.2 (10.0) and 60.6 (9.0) years for individuals of African descent and of European descent, respectively; 94 (52%) and 86 (48%) of individuals of African descent and of European descent were women, respectively. The mean SD of the residuals was larger in eyes of individuals of African descent vs those of European descent (1.45 [0.83] dB vs 1.12 [0.48] dB; mean difference: 0.33 dB; 95% CI of the difference, 0.21-0.46; P < .001). The eyes in individuals of African descent had a larger increase in variability with worsening disease (P < .001). When simulations were performed assuming common progression scenarios, there was a delay to detect progression in eyes of individuals of African descent compared with those of European descent. For a scenario with baseline mean deviation of -10 dB and rate of change of -0.5 dB/y, detection of progression in individuals of African descent was delayed by 3.1 (95% CI, 2.9-3.2) years, when considered 80% power and annual tests. Conclusions and Relevance: Patients of African descent with glaucoma showed increased visual field variability compared with those of European descent, resulting in delayed detection of progression that may contribute to explain higher rates of glaucoma-related visual impairment in individuals of African descent compared with those of European descent with glaucoma.
Authors: Felipe A Medeiros; Carolina P B Gracitelli; Erwin R Boer; Robert N Weinreb; Linda M Zangwill; Peter N Rosen Journal: Ophthalmology Date: 2014-10-16 Impact factor: 12.079
Authors: Hochang B Lee; Amanda K Richardson; Betty S Black; Andrew D Shore; Judith D Kasper; Peter V Rabins Journal: Aging Ment Health Date: 2011-10-14 Impact factor: 3.658
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Authors: Thaissa Nazareth; Janaina Rocha; Ana Luiza B Scoralick; Diego T Dias; Carolina P B Gracitelli; Fabio N Kanadani; Tiago S Prata Journal: Clin Ophthalmol Date: 2020-12-02
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Authors: Brian Stagg; Eduardo B Mariottoni; Samuel Berchuck; Alessandro Jammal; Angela R Elam; Rachel Hess; Kensaku Kawamoto; Benjamin Haaland; Felipe A Medeiros Journal: Br J Ophthalmol Date: 2021-05-13 Impact factor: 5.908
Authors: Maria Emília V Guimarães; Carolina P B Gracitelli; Syril Dorairaj; Fábio N Kanadani; Tiago S Prata Journal: J Ophthalmol Date: 2019-12-09 Impact factor: 1.909
Authors: Shounak Datta; Eduardo B Mariottoni; David Dov; Alessandro A Jammal; Lawrence Carin; Felipe A Medeiros Journal: Sci Rep Date: 2021-06-15 Impact factor: 4.379