Risk factors for late presentation of chronic glaucoma

Objectives. Existing evidence indicates that late presentation of glaucoma (i.e. advanced visual field loss) is an important risk factor for subsequent blindness. This study was designed to identify the risk factors for first presenting to an NHS ophthalmologist with advanced glaucomatous visual field loss by comparing with a group who presented with early loss.;Design. Hospital-based case-control study with prospective identification of cases and controls.;Setting. Three Hospital Eye Departments in England.;Subjects. Consecutive patients newly diagnosed with glaucoma (n=220). Cases were those presenting with advanced glaucoma (n=110), controls were those with early glaucoma (n=110). Patients with a previous history of ocular hypertension or any documented suspicion of glaucoma (within the Hospital Eye Service) were excluded.;Results. Those participants who presented with advanced visual field loss were more likely to be older, of African-Caribbean origin, more socioeconomically disadvantaged (at both an area and an individual level), to have left school earlier and to have a higher IOP compared with those who presented with early field loss. The early presenters were more likely to have had a sight test within the previous five years and were more likely to report a family history of glaucoma. Most of the excess risk of those of African-Caribbean origin appeared to be due to a low rate of sight test attendance compared to non-African-Caribbean's. Educational level and Socioeconomic status although independently associated with each other were independent risk factors.;Conclusions. Certain groups of patients, indicated above, are at greater risk of presenting to the Hospital Eye Service with advanced, irremediable sight loss and are at high risk of subsequent blindness.