Prognosis of glaucoma in relation to blindness at a university hospital

Purpose: To assess the prognosis of different types of glaucoma in relation to unilateral and bilateral blindness at a University Hospital. Methods: Charts of glaucomatous patients which presented complete data of clinical history, visual acuity, visual field, fundus examination and diagnosis were retrospectively analyzed. The patients were classified as: not blind, legally blind (best corrected visual acuity <= 20/200 and/or visual field <= 20 degrees), or totally blind (no light perception) in one or both eyes. Patients with blindness due to congenital glaucoma and other no glaucomatous causes, and incomplete charts were excluded. Results: 3,786 (76.3%) of 4,963 charts fulfilled the criteria. In 3,786 glaucomatous patients, 1,939 (51.2%) were not blind and 1,847 (48.8%) were blind. 1,359 patients (73.6%) were legally blind and 488 (26.4%) totally blind, 1,333 (72.2%) had unilateral blindness and 514 (27.8%), bilateral blindness. 1,564 patients (84.7%) were already blind (74.9% with legal blindness and 25.1% with total blindness) when they arrived at the Service and 283 (15.3%) became blind after their inclusion in the Service. Neovascular glaucoma presented the highest proportion (95.6%) of blindness. Postsurgical glaucoma was second causing blindness in 72.7% and thirdly, primary angle-closure glaucoma with 67.4%. Primary open-angle glaucoma presented the lowest proportion (40.5%) of blindness. Conclusions: Neovascular glaucoma had the worst prognosis with the highest proportion of blindness. Primary angle-closure glaucoma caused blindness roughly 1.7 times more than primary open-angle glaucoma. Primary open-angle glaucoma presented the best prognosis. The proportion of patients that became blind after their inclusion in the Service was relatively low in relation to the proportion of patients who were blind when they arrived at the Service.