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Title: Investigation of risk factors that precede primary open angle glacoma
Author: Hirani, S.
ISNI:       0000 0004 7229 1935
Awarding Body: London South Bank University
Current Institution: London South Bank University
Date of Award: 2018
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Primary open angle glaucoma (POAG) is characterized by progressive degeneration of the retinal ganglion cells, resulting in optic nerve atrophy with visual field defects. The biological basis of POAG is not fully understood. This thesis covers two studies. The aims for Study 1 were to investigate the risk factors of glaucoma in a population aged 18 years to 40 years. These were investigated by a retrospective study of intraocular pressure measurements and optic nerve assessments (cup to disc ratio) in two groups. One group had a family history of glaucoma and a second group was without a family history of glaucoma. The aims for Study 2 were to investigate whether the risk factors for primary open angle glaucoma were present many years before glaucoma develops. These were investigated with a retrospective review of intraocular pressure measurements and optic nerve measurements in participants who subsequently developed primary open angle glaucoma. Each study collected anonymised retrospective data from community optometry clinics for extraction and analysis of data on intraocular pressure measurements and optic nerve assessments. Study 1 collected one data entry per case. Study 2 collected ten years of historical data from each clinical visit from clinical records of participants prior to their diagnosis/treatment of glaucoma. This data spanned 33 years. For each glaucoma record, data for a similar period were obtained from a case-matched control record. The results for Study 1 are that mean intraocular pressure measurements and optic nerve head assessments in young adults aged between 18 years and 40 years did not differ significantly in cases with a family history of glaucoma compared with a group without. For Study 2, the correlations of intraocular pressure and optic nerve cup to disc ratio indicate an increase in values over a 10-year duration for cases that subsequently developed glaucoma as compared to case-matched controls. Analyses conducted at 5 and 10-year time points for mean intraocular pressure and median optic nerve cup to disc ratios prior to POAG diagnosis were statistically significantly different (p < 0.05). Visual field data were collected for all the cases and descriptive data showed that pre-diagnosed cases had more reported suspicious visual field defects. The principle findings of this thesis are that there are pre-glaucomatous changes up to ten years before glaucoma diagnosis and that this may have considerable relevance for models of glaucoma aetiology. It also highlights the important role that community optometrists play in guarding the borders between pre-glaucoma and glaucoma.
Supervisor: Evans, Bruce ; Edgar, David ; Allen, Peter Sponsor: Not available
Qualification Name: Thesis (D.Prof.) Qualification Level: Doctoral