Because glaucoma inevitably progresses despite medical and surgical therapies, it’s important to study the duration of certain interventions and their effects on long-term visual outcomes. Recently, researchers evaluated the lifetime visual outcomes of patients who’d undergone trabeculectomy in a prospective study of patients who had died prior to the study evaluation point.
Their researched spanned 18 years, from 2000 to 2018, and by the evaluation point, 160 of the 659 patients had died. A total of 156 patients (196 eyes) had data sufficient for the study (86% white, 3:2 male-to-female ratio, average age at first-eye surgery was 76.5±9). For this population, life expectancy post-trabeculectomy was 7.5 years.
The researchers found that by end of life, mean change in visual acuity was 0.32±0.59 logMAR and visual field mean deviation progressed at a median of -0.44dB/year from -5.98 to 3.9 for eyes with at least a year of follow-up data.
Severe vision loss, defined as greater than or equal to 10 letters on the logMAR scale, occurred in 40% of eyes. Of those with severe vision loss, 9% was due to glaucoma, and 44% of patients required glaucoma drops at end of life.
The researchers concluded that “trabeculectomy is successful in slowing or preventing further glaucoma progression and maintaining visual function in the majority of eyes for the remainder of life.” They noted that “for eyes with severe vision loss at end of life, only one in four was due to further glaucoma progression.”
Chen R and King AJ. Lifetime visual outcomes of patients undergoing trabeculectomy. Br J Ophthalmology. September 19, 2020. [Epub ahead of print].