Abstract
PURPOSE: To investigate the incidence of perimetric glaucoma and the effectiveness of interventions in eyes with pseudoexfoliation syndrome (PXF) with and without ocular hypertension (OHTN). DESIGN: Retrospective cohort study SUBJECTS: Eyes with documented PXF between 2016 and 2023 at a tertiary referral hospital. METHODS: We applied two natural-language processing models to identify patients with pseudoexfoliation and, through chart review, confirmed PXF status among those who had undergone a Humphrey Visual Field (HVF) test. Glaucoma incidence was defined using consecutive glaucoma-positive HVFs labelled by PyGlaucoMetrics (https://github.com/Mousamoradi/PyGlaucoMetrics), which employ validated algorithms to estimate glaucoma probability from reproducible HVF data. We estimated the cumulative incidence of perimetric glaucoma using the Kaplan-Meier method and a multivariable Cox regression model to identify factors associated with glaucoma incidence. Outcomes of procedural interventions were evaluated. MAIN OUTCOME MEASURES: Glaucoma incidence rates. RESULTS: 485 eyes from 369 patients were included. The 4-year cumulative incidence rates of perimetric glaucoma were 26.5% (95% confidence interval (CI): 20.7-32.0%) in eyes without OHTN and 37.5% (95% CI: 24.3-48.4%) in those with OHTN (log-rank test, P = 0.005). Factors associated with incident glaucoma were older age (HR: 1.39 [95% CI: 1.19-1.62], per 5 years), OHTN (2.18 [1.39-3.42]), higher cup-to-disc ratio (CDR, 1.17 [1.04-1.31], per 0.1 higher CDR), and phakia (1.94 [1.13-3.34]). During follow-up, incident OHTN was observed in 14.6% of eyes with PXF without baseline OHTN. However, 87.3% of eyes that developed glaucoma had no documented OHTN, based on measured IOP at any office visit. Standalone lens extraction reduced the mean IOP from 15.8 ± 2.5 mmHg with 0.40 ± 0.78 medications preoperatively to 12.9 ± 2.7 mmHg with 0.28 ± 0.57 medications at 1 year postoperatively. CONCLUSIONS: More than one-fourth of eyes with documented PXF without OHTN and more than one-third of those with OHTN developed perimetric glaucoma within 4 years. Older age, OHTN, higher CDR, and phakia were associated with incident glaucoma. Nearly 90% of eyes with normal baseline IOP that later developed glaucoma had no documented OHTN at any office visit. Standalone lens extraction reduced IOP by 3 mmHg at 1 year postoperatively.