Predictors of Visual Acuity, Intraocular Pressure, and Pain in Neovascular Glaucoma: A Mixed-Effects Model and Machine Learning Cohort Analysis
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Background/Aims
Neovascular glaucoma (NVG) is a severe, secondary glaucoma. This study aimed to identify factors associated with vision, intraocular pressure (IOP), and ocular pain outcomes.
Methods
The cohort included all patients diagnosed with NVG during 2008–2024 at Helsinki University Hospital, Finland. Linear mixed-effects models used pre-specified covariates, whereas machine learning was given the full longitudinal data with biomicroscopic findings as an exploratory approach.
Results
626 patients were analysed. Worse baseline vision and a closed angle were associated with worse follow-up vision. Treatments were associated with lower IOP and less pain rather than better vision. Age, sex and comorbidity were largely not associated with the outcomes. Glaucoma drainage devices showed the greatest initial IOP reduction (−10.2 mmHg, 95% confidence interval, CI −11.9 to −8.6 mmHg), followed by transscleral cyclophotocoagulation (TSCPC, −4.7 mmHg, 95% CI −5.8 to −3.7 mmHg) and peripheral retinal cryotherapy (−2.2 mmHg, 95% CI −3.1 to −1.4 mmHg). TSCPC and cryotherapy were also associated with reduced pain (odds ratio 0.51 and 0.46). Pan-retinal photocoagulation and anti-VEGF showed smaller IOP reductions, with a pain reduction for pan-retinal photocoagulation only. Both methods agreed, and machine learning added no novel clinical findings.
Conclusions
Vision in this cohort was largely set by the state of the eye at diagnosis. IOP control and pain relief therefore remain realistic goals even when sight cannot be saved. Peripheral retinal cryotherapy stood out, linked to both lower IOP and less pain, seldom reported in NVG. These associations from a large, unselected cohort identify treatments worth comparing prospectively.
Key Messages
What is already known on this topic
Neovascular glaucoma has a poor visual prognosis. Treatments have mostly been assessed in operated patients as surgical success or failure, rather than by their associations with vision, IOP and pain across the disease course.
What this study adds
Treatments were associated mainly with lower intraocular pressure and less pain, not with better vision, which baseline severity largely determined. Peripheral retinal cryotherapy was associated with lower IOP and less pain, an effect seldom reported.
How this study might affect research, practice or policy
Intraocular pressure control and pain relief remain achievable goals, whereas visual prognosis is largely set at presentation.
Précis
In 626 neovascular glaucoma patients followed over 12,000 visits, baseline severity shaped visual prognosis. Treatments were associated with lower intraocular pressure and less ocular pain but rarely better vision. Mixed-effects models and machine learning agreed.
