Nonprogressive glaucomatous cupping and visual field abnormalities in young Chinese males

Ophthalmology. 2007 Mar;114(3):472-9. doi: 10.1016/j.ophtha.2006.07.036. Epub 2006 Nov 21.

Abstract

Objective: To describe a series of young to middle-aged men of Chinese origin who presented with a constellation of ocular findings suggestive of glaucoma, that were found to be stable over a 7-year period.

Design: Retrospective case series.

Participants: Sixteen 25- to 66-year-old male patients.

Methods: Medical records of the participants, of Chinese origin and referred for glaucoma evaluation over a 7-year period, were reviewed. All patients underwent complete ophthalmic examinations, stereo imaging of the optic nerves, and automated perimetry. Fewer than 5% of all patients seen in this practice were of Chinese origin. The patients were observed for the duration of the study in a single glaucoma clinic.

Main outcome measures: Visual field (VF) changes or progressive optic nerve cupping suggestive of glaucoma.

Results: The patients had an average age of 38.9 years. Tilted discs were present in 75.0% (24/32) and peripapillary atrophy in 81.3% (26/32) of nerves. Cup-to-disc ratios ranged from 0.20 to 0.95 and averaged 0.56. The lowest intraocular pressure (IOP) in any patient at any time was 8 mmHg, whereas the highest was 29 (average range, 13.5-17.9). Intraocular pressure-lowering therapy had been used in 56.3% (9/16). There was a family history of presumed glaucoma in 25.0% (4/16) of patients. High myopia (>-6.00-diopter spherical equivalent [SE]) was present in 43.8% of eyes (14/32), and SEs ranged from -11.25 to +0.25. The most common VF defect was an arcuate defect, found in 31.3% (10/32) of patients. There were no females of Chinese origin with similar findings identified during this period. Neither optic nerve nor significant VF progression was found during the follow-up period, regardless of the use of IOP-lowering therapy.

Conclusions: These young Chinese patients previously diagnosed with glaucoma or considered glaucoma suspects had stable ocular findings for up to 7 years, irrespective of IOP-lowering therapy. Their condition was associated with myopia and tilted discs. Many were being treated with IOP-lowering therapy for glaucoma, a condition they may not have had. Further prospective epidemiologic study is needed to determine whether such a constellation of nonprogressive findings is more common in young Chinese males than in the general population.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Asian Americans*
  • Diagnostic Techniques, Ophthalmological
  • Disease Progression
  • Glaucoma / complications
  • Glaucoma / drug therapy
  • Glaucoma / pathology*
  • Glaucoma / physiopathology*
  • Humans
  • Intraocular Pressure / drug effects
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Myopia / complications
  • Optic Nerve / pathology*
  • Retrospective Studies
  • Vision Disorders / etiology
  • Visual Field Tests
  • Visual Fields*