Rates of visual field progression in clinical glaucoma care

Abstract

Purpose: To investigate rates of visual field progression and factors associated with progression rate in open-angle glaucoma in clinical glaucoma care.

Methods: We performed a retrospective chart review of all patients with manifest primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG) followed ≥ 5 years with ≥5 SITA Standard fields. Exclusion criteria were minimal. Demographics, intraocular pressure values (IOP), treatment and treatment changes, and visual field (VF) data were recorded. VF progression rates were calculated as slopes of mean deviation (MD) over time.

Results: Five hundred and eighty-three patients were eligible. Three hundred and sixty-seven (62%) had POAG and 221 (38%) PEXG. Median MD at study start was -10.0 dB. Mean follow-up time was 7.8 years (SD ± 1.2); mean number of VF tests was 8.9 (SD ± 2.8). Progression rates varied very much among patients with a mean of -0.80 dB/year (SD ± 0.82; median rate, -0.62), and 5.6% of patients progressed at rates worse than -2.5 dB per year A negative slope of MD values was observed in 89% of patients. Mean IOP of all visits decreased over the study period from 20.15 to 18.10 mmHg. Higher age and mean IOP, and more intensive treatment were associated with more rapid progression, while PEXG and IOP variation were not, if treatment intensity was taken into account.

Conclusion: Rates of visual field progression in manifest glaucoma with field loss in ordinary clinical care were highly variable. Progression rates rapid enough to influence quality of life were common.

Keywords: Glaucoma; progression; rate of progression; visual field.

Fig 1

Mean deviation (MD) at the beginning of the follow-up period. The whole spectrum of glaucomatous field loss is covered. The median MD (−10.0 dB) corresponds to moderately advanced glaucoma.

Fig 2

Rates of progression expressed in dB/year. The distribution is wide and has a negative tail of rapidly progressing eyes.

Fig 3

Mean intraocular pressure (IOP) over time ±1 standard deviation for all eyes (A), for the group of eyes with primary open-angle glaucoma (B) and exfoliation glaucoma (C). IOP decreased slowly over time.