Study to Identify and Evaluate Predictor Factors for Primary Open-Angle Glaucoma in Tertiary Prophylactic Actions

Abstract

The aim of this study is to develop a predictive model with several explanatory variables that can guide ophthalmologists to make a more objective assessment of the evolution of open-angle glaucoma (OAG) during tertiary prevention. Objectives: The evaluation of risk factors and different predictors of symptom progression between patients with POAG and non-glaucoma patients (NG), as well as between primary open-angle glaucoma with high intraocular pressure (POAG) and primary open-angle glaucoma with normal intraocular pressure (NTG), in tertiary prophylactic activities. Methods: This research is an analytical epidemiological study of a prospective cohort. For the study, we took into account personal medical history, physical ophthalmological examination, intraocular pressure (IOP) values, and visual field (VF) parameters, examined with the Opto AP-300 Automated Perimeter using the “fast threshold” strategy. The results of gonioscopy were inconsistently recorded; they were not considered in the study due to missing values, the processing of which would have seriously distorted the statistical analysis. Ophthalmological examination was completed with a dichotomous questionnaire entitled “Symptom Inventory”, made according to the accusations of patients resulting from a “focus group” study. The study was carried out in the ophthalmology office within the Integrated Outpatient Clinic of the Emergency Clinical Hospital of Oradea, Bihor County (IOCECHO) between January–December 2021. The threshold of statistical significance was defined for p value < 0.05. The obtained results were statistically processed with specialized software SPSS 22. Results: The study included 110 people, of which 71 (64.54%) had POAG (IOP > 21 mmHg) and 39 people (35.46%) had NTG (IOP < 21 mmHg), the two groups being statistically significantly different (χ2 = 9.309, df = 1, p = 0.002). For the POAG group, glaucomatous loss was early, AD < −6 dB, according to the staging of glaucomatous disease, HODAPP classification. In addition, the groups of POAG and NTG patients was compared with a group of 110 NG patients, these three groups being statistically significantly different (χ2 = 34.482, df = 2, p = 0.000). Analysis of confounding factors (age, sex, residence, marital status) shows a statistically significant relationship only for age (F = 2.381, df = 40, p = 0.000). Sex ratio for the study groups = 5.11 for OAG and =5.87 for NG. After treatment (prostaglandin analogues and neuroprotective drugs) IOP decreased statistically significantly for both POAG and NTG. Conclusions: this study identified possible predictors of OAG, at the 5% level (risk factors and symptoms as independent variables) using a dichotomous questionnaire tool with a complementary role in tertiary prophylactic activities. The implementation of the focus group interview results as a socio-human research technique will be supportive to clinicians.