Race/ethnicity in relation to incident primary open-angle glaucoma characterized by autonomously determined visual field loss patterns

Abstract

ABSTRACTPurposeWe used an autonomous algorithm to classify incident visual field (VF) loss patterns in primary open-angle glaucoma (POAG). Subsequently, we compared racial differences in the risk of these regional VF loss patterns.Design/ParticipantsParticipants (n=209,036) from the Nurses’ Health Study (NHS) (follow-up: 1980-2018); NHS2 (1989-2019); and Health Professionals Follow-up Study (HPFS; 1986-2018), aged ≥40 years and free of glaucoma.MethodsDemographics, medical and lifestyle information was assessed on biennial questionnaires. Incident POAG cases (n=1946) with reproducible Humphrey VF loss were confirmed with medical records. The total deviation information of the earliest reliable VF for each eye with POAG (n=2564) was extracted, and a statistical learning method was used to identified optimal solutions for regional vision loss patterns. Each POAG eye was assigned the VF pattern (“archetype”) based on the highest weighting coefficient.Multivariable-adjusted hazard ratios (HRs) for POAG of various archetypes and 95% confidence intervals (CIs) were estimated using per-eye Cox proportional hazards models. Covariates included cohort, age, glaucoma family history, socioeconomic status, lifestyle parameters, number of eye exams during follow-up, and medical conditions. False discovery rate (FDR) was used for multiple comparisons.Main outcome measuresPOAG based on VF patterns.ResultsMean age was 58 years; 1.3% were Black, 1.2% were Asian, 1.1% were Hispanic-White and 96.4% were non-Hispanic White. We identified 14 archetypes: 1 representing no VF loss, 9 of early loss and 4 of advanced loss patterns. Compared to non-Hispanic Whites, Blacks were at significantly higher risk of POAG with early VF loss archetypes collectively (Blacks: HR=1.96, 95% CI=1.46, 2.63) and at even higher risk for POAG with advanced loss archetypes collectively (Blacks: HR=6.07, 95% CI=3.61, 10.21; p=0.0002 for the two estimates being different); no differences were observed for Asians or Hispanic Whites. For individual VF archetypes, Hispanic-Whites had FDR-significant higher risks of POAG of archetypes showing early paracentral defects and advanced superior loss while Blacks had FDR-significant higher risks of all advanced loss archetypes and 3 early loss patterns, including early paracentral defects.ConclusionAmong health professionals, compared to non-Hispanic-Whites, Blacks and Hispanic-Whites had higher risks of incident POAG with central and advanced VF loss.