Glaucoma patients with uveitis have a much higher age-corrected rate of rapid visual field loss than people with primary open-angle glaucoma (POAG) alone, a large UK-based study reports.

The investigation, using real-world data from five glaucoma clinics in England, also reported that eyes with glaucoma and uveitis had nearly double (1.9x) the risk of disease progression compared with those with POAG, yet the average frequency of visual field monitoring was the same for both diseases—about 10 months.

The study included 205 donor eyes with uveitis and glaucoma and 4,600 POAG-only eyes. Eyes with uveitis presented with worse median mean deviation (MD) than those with POAG (–3.8dB vs. –3.1dB), leading researchers to speculate that early visual field loss may be under-detected in uveitic glaucoma. Researchers also noted 11% of the eyes with glaucoma and uveitis progressed ≥ 1.5dB, while only 7% of POAG eyes progressed.

Secondary analysis of intraocular pressure (IOP) parameters showed no difference in the mean IOP between the two groups. However, the researchers noticed the IOP range was wider in the fast progressing eyes of both groups, with the widest range in the progressing uveitic glaucoma group (a range of 21mm Hg). 

By identifying rapid progressors early, clinicians can target interventions to preserve visual function in this high-risk group, the researchers noted. “Our findings suggest that patients with a combination of uveitis and glaucoma lose vision more rapidly than POAG, yet on average they are monitored with visual fields at the same intensity,” they wrote.

As such, clinicians managing patients with uveitis should remain vigilant for glaucoma damage in these high-risk patients, the study suggests. 

Liu X, Kelly SR, Montesano G, et al. Evaluating the impact of uveitis on visual field progression using large scale real-world data. Am J Ophthalmol. June 25, 2019. [Epub ahead of print].