Central corneal thickness as a risk factor for advanced glaucoma damage.

OBJECTIVE To determine if central corneal thickness (CCT) is related to the level of glaucoma severity at the initial examination. METHODS The initial visit to a glaucoma specialist by consecutive patients with primary open-angle glaucoma from 1997 to 2002 was reviewed retrospectively. Each patient's age, sex, race, family history of glaucoma, number of glaucoma medications, visual acuity, spherical equivalent, intraocular pressure, CCT, visual field data, and vertical and horizontal cup-disc ratios were analyzed. RESULTS Three hundred fifty eyes of 190 patients met the inclusion and exclusion criteria. Central corneal thickness was significantly lower in blacks (mean, 537 microm) than in whites (mean, 556 microm). Lower CCT was significantly associated with worsened Advanced Glaucoma Intervention Study score, worsened mean deviation of visual field, increased vertical and horizontal cup-disc ratios, and increased number of glaucoma medications. In multivariate analysis, lower CCT was significantly associated with worsened Advanced Glaucoma Intervention Study score, worsened mean deviation of visual field, and increased vertical and horizontal cup-disc ratios. CONCLUSIONS Central corneal thickness is a powerful clinical factor in determining glaucoma severity at the initial examination by a specialist. Measuring CCT may aid the ophthalmologist in identification of glaucoma patients at high risk for progression.