Visual Outcomes and Risk Factors for Progression in Juvenile Open-Angle Glaucoma

To report the visual outcomes of patients diagnosed with juvenile open-angle glaucoma (JOAG) at presentation and final follow-up and to analyze the rate of visual impairment progression and associated risk factors.

A retrospective clinical cohort study.

This retrospective study included all patients diagnosed with JOAG over 13 years from 2 tertiary hospitals in Bangkok, Thailand, with a minimum follow-up of 1 year.

We categorized visual impairment and blindness according to the World Health Organization criteria at both the initial presentation and the final follow-up visit. Progression was defined as a shift to a more severe category of visual impairment in each eye; we identified the risk factors associated with visual impairment progression.

The proportions of visual impairment and blindness at the beginning and end of the study period. The progression rates of visual impairments were calculated at 1, 3, and 5 years.

We included a total of 203 eyes from 106 patients in this study. At the initial assessment, 31.5% of eyes were blind, and this percentage significantly increased to 35.5% (P < 0.001) after an average follow-up of nearly 8 years. Bilateral blindness in patients rose from 15.2% to 19.8% (P < 0.001) over the same period. Among patients without visual impairment at presentation, 96.3%, 93.1%, and 87.7% maintained stable vision at 1, 3, and 5 years, respectively. In comparison, patients with moderate visual impairment had stable outcomes in 84.6%, 67.7%, and 67.7% of cases at the same time points. However, the progression rates of visual outcomes did not significantly differ across varying visual impairment categories (P = 0.08). A higher number of glaucoma surgeries per patient was identified as an associated factor for visual impairment progression (adjusted hazard ratio = 2.25; 95% confidence interval: 1.34-3.78, P = 0.002).

Juvenile open-angle glaucoma is associated with severe visual impairment both at initial presentation and after treatment. Despite slow progression, more than 10% of patients experienced worsening vision over 5 years, with the number of glaucoma surgeries being a significant associated factor for progression. Lifelong follow-up and early detection are crucial in reducing morbidity in this patient group.

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