Relationship between Severity of Visual Field Loss at Presentation and Rate of Visual Field Progression in Glaucoma

doi:10.1016/j.ophtha.2010.05.027

Ophthalmology

Volume 118, Issue 2, February 2011, Pages 249-253

https://doi.org/10.1016/j.ophtha.2010.05.027 Get rights and content

Purpose

To evaluate the relationship between severity of visual field (VF) loss at presentation and rate of VF progression in glaucoma.

Design

Clinic-based, retrospective study.

Participants

We included 512 eyes of 310 primary glaucoma patients.

Methods

We analyzed the VFs of all subjects of primary glaucoma who had >5 VFs between 1989 and 2008. Based on the mean deviation (MD), we classified the VF loss as mild (MD > −6 dB), moderate (MD ≤ −6 to ≥ −12 dB) or severe (MD < −12 dB). Guided Progression Analysis software which gives the rate of progression (ROP) of Visual Field Index per year was used to assess the ROP.

Main Outcome Measures

Relationship between severity of VF loss at presentation and ROP.

Results

The median duration of follow-up was 6.8 years. The ROP increased (worsened) by 0.02% per year for every dB worsening of MD (P = 0.02) and for every year of increasing age (P = 0.001). Association between MD and ROP showed a significant positive relationship in mild (β = 0.18; P = 0.001) and a significant negative relationship in severe (β = −0.16; P<0.001) VF loss category. Association between MD and ROP was not significant in the moderate VF loss category (β = −0.05; P = 0.61).

Conclusions

In early stages of glaucoma, the ROP worsened as the severity increased, but, in later stages of the disease, ROP became smaller as the severity increased. There is a need for better methods to detect progression in eyes with severe glaucomatous damage.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Methods

In this clinic-based, retrospective study, all patients diagnosed with primary open-angle (POAG) and primary angle closure glaucoma (PACG), who had undergone >5 Humphrey VF examinations (either full threshold or Swedish Interactive Threshold Algorithm-standard, either 24-2 or 30-2, or a combination) between 1989 and 2008 were identified. This study was approved by the ethics committee of the LV Prasad Eye Institute.

For purposes of the study, POAG was defined in the presence of an IOP >21 mmHg,

Results

Five hundred forty-seven eyes of 335 patients, with a diagnosis of either POAG or PACG and treated by a single physician, had undergone >5 Humphrey VF examinations at our institute between 1989 and 2008. Of these, 10 eyes were excluded because of poor reliability. Five eyes that developed vein occlusions, 1 that developed a retinal detachment, and 2 eyes of 1 patient who developed a cerebral infarct during the follow-up were excluded from analysis. We also excluded 17 eyes of 10 subjects (7

Discussion

In this large, clinic-based cohort, managed over a long period of time, we found the ROP in glaucoma to be dependent on the severity of VF loss at presentation, as measured by the MD. We also found that the ROP increased as the severity increased in early stages of glaucoma damage and became smaller as the severity increased in the later stages of the disease. We also demonstrated that linear fit may not represent the association between the ROP in glaucoma and the severity of VF loss at

References (23)

A.L. Coleman et al.
Risk factors for glaucoma onset and progression
Surv Ophthalmol
(2008)
W.C. Stewart et al.
Factors associated with long-term progression or stability in primary open-angle glaucoma
Am J Ophthalmol
(2000)
P.R. Lichter et al.
Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery
Ophthalmology
(2001)
T.M. Eid et al.
Rate and amount of visual loss in 102 patients with open-angle glaucoma followed up for at least 15 years
Ophthalmology
(2003)
B. Bengtsson et al.
A visual field index for calculation of glaucoma rate of progression
Am J Ophthalmol
(2008)
K. Nouri-Mahdavi et al.
Predictive factors for glaucomatous visual field progression in the Advanced Glaucoma Intervention Study
Ophthalmology
(2004)
J.L. Rivera et al.
Risk factors for primary open angle glaucoma progression: what we know and what we need to know
Curr Opin Ophthalmol
(2008)
The Advanced Glaucoma Intervention Study (AGIS): 12Baseline risk factors for sustained loss of visual field and visual acuity in patients with advanced glaucoma
Am J Ophthalmol
(2002)
M.C. Leske et al.
Factors for glaucoma progression and the effect of treatment: the Early Manifest Glaucoma Trial
Arch Ophthalmol
(2003)
S.D. Smith et al.
Analysis of progressive change in automated visual fields in glaucoma
Invest Ophthalmol Vis Sci
(1996)

M.T. Rasker et al.

Rate of visual field loss in progressive glaucoma

Arch Ophthalmol

(2000)

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Visual impairment (VI) negatively impacts the quality of lives of individuals and the optimal health of populations, creating both human and financial costs. Yet, VI has not risen to a level that is considered a priority in population health. This analysis assesses the evidence currently available for strengthening the value proposition for eye health, particularly the demographic characteristics and patient-centered outcomes found in clinical research.
Retrospective cross-sectional analysis.
Two searches of the AJO database were performed using relevant key words: Search 1 (S1): NEI-sponsored clinical trials (1970-2023); and Search 2 (S2): Quality of life (2018-2023). The Scopus Cite Score was used as a filter for each search, specifically ≥50 for S1 and ≥20 for S2.
Of the initial 466 articles found, 100 met the preestablished criteria. Age, sex, and race/ancestry/ethnicity were reported across glaucoma, retina, uveitis, cornea, and pediatrics subspecialties in 56% ± 9.7% of the articles; 37% ± 9.5% listed either age only or age, sex, or gender. The characterizations varied and subcategories were rarely reported. Only 2% of S1 and 25% of S2 noted patient-centered outcomes.
The characterization of study populations in the ophthalmic literature is limited by underreporting of patient-centered outcomes, useful for reaffirming the value of eye and vision health in population health. This analysis highlights the need for paying greater attention to more specific demographic categories and focusing more on patient-centered outcomes in clinical research.
Predictive Factors for the Rate of Visual Field Progression in the Advanced Imaging for Glaucoma Study
2019, American Journal of Ophthalmology
Citation Excerpt :
Therefore, methods for using baseline data to stratify the risk of future progression would be most helpful in planning the monitoring frequency and treatment strategy in this situation. While many studies have investigated the factors that predict the risk of developing statistically significant VF progression,2,5,6,15–20 or the factors that influence the average rate of progression in a group of patients,21 few studies have examined factors that predict which glaucoma patients or eyes are more likely to have rapid versus slow rate of VF deterioration.22–24 Furthermore, none of the studies have related the speed of VF progression to baseline OCT findings.
To investigate predictive factors associated with the rate of visual field (VF) loss in open-angle glaucoma.
Prospective multicenter cohort study.
Perimetric glaucoma patients of the Advanced Imaging for Glaucoma study were selected for analysis if they had 9 completed visits. Confirmed rapid significant progression (CRSP) of VF was defined as a significant (P < 0.05) negative VF index (VFI) slope of −1%/year or a mean deviation slope of −0.5 dB/year, confirmed at 2 consecutive follow-up visits. Slow progression was defined as VFI slope greater than −0.5%/year or a mean deviation slope of −0.25 dB/year. Fourier-domain optical coherence tomography (FD-OCT) measured optic disc, peripapillary retinal nerve fiber layer (NFL), and macular ganglion cell complex (GCC) thicknesses. Logistic regression was used to identify baseline predictors for CRSP and slow progression. Linear regression was used to identify baseline predictors for the VFI and mean deviation slope.
Eyes (n = 150) of 103 participants were included. Slow progression was observed in 80 eyes (53.3%) and CRSP in 23 eyes (15.3%). Larger NFL and GCC baseline focal loss volume (FLV), thinner central corneal thickness, and lower VFI were significant (P < 0.05) baseline predictors of more rapid progression on univariate analysis. The predictor with the highest odds ratio (OR) was NFL-FLV, which was also the most significant non-VF predictor in the multivariate analysis. Eyes with NFL-FLV >8.5% had an OR of 2.67 for CRSP and 0.42 for slow progression. Disc hemorrhage during the follow-up was also important, with an OR of 2.61 for CRSP and 0.23 for slow progression for each occurrence.
Focal loss measured by FD-OCT or VF along with CCT are strong baseline predictors for the rate of glaucoma progression.
Distribution and Rates of Visual Field Loss across Different Disease Stages in Primary Open-Angle Glaucoma
2018, Ophthalmology Glaucoma
Citation Excerpt :
Because of different vulnerabilities of ganglion cells, the pathophysiology of any patterns of POAG could be different. The rate of VF loss in POAG eyes has been studied by different groups;24–35 however, a comprehensive analysis presenting both patterns and rates of VF loss of POAG eyes using a large cohort with long-term follow-ups has been lacking. We found that the rate of VF loss was faster in eyes at the early stage than in the moderate stage of glaucoma (−0.2 dB/year and −0.12 dB/year, respectively; P = 0.02).
To identify patterns and rates of visual field (VF) loss in primary open-angle glaucoma (POAG) across different levels of severity.
Retrospective, observational case series.
Visual fields of 278 eyes of 139 patients with POAG (9 years of follow-up with ∼17 visits) from the Rotterdam Eye Hospital in The Netherlands were analyzed to identify patterns and rates of VF loss.
Rate of VF decline for the entire VF, each region, and test point. Hemifield asymmetric rate if VF decline for each region and test point.
Total deviation (TD) values were extracted from the Humphrey VF Analyzer (Carl Zeiss Meditec, Dublin, CA). Eyes were stratified into 3 glaucoma stages by means of the mean deviation (MD): better than −6 decibels (dB), worse than −6 dB and better than −12 dB, and worse than −12 dB. Each hemifield was divided into 5 regions according to the Glaucoma Hemifield Test (GHT): central, paracentral, nasal, and peripheral arcuates 1 and 2. Point-wise and region-wise asymmetric patterns of VF loss and rate of VF loss were identified by comparing the values in the superior hemifield and the inferior hemifield at each severity level using a generalized estimating equation.
The mean age of the patients was 60.2±10.3 years (mean ± standard deviation [SD]). The rate of MD loss, for all eyes taken together, was −0.11 dB/year. In the cross-sectional analysis, in eyes in the early and moderate stages, central and peripheral arcuate 2 regions in the superior hemifield were worse than their inferior counterpart, whereas in the advanced stage all GHT regions in the superior hemifield were significantly worse than the corresponding regions in the inferior hemifield (P ≤ 0.05). In the longitudinal analysis, there was no significant difference in the rate of VF loss between the GHT regions in the superior and inferior hemifields.
Our findings suggest that in POAG, VF damage is worse in the superior hemifield than in the inferior hemifield.
Using Fused Data from Perimetry and Optical Coherence Tomography to Improve the Detection of Visual Field Progression in Glaucoma
2024, Bioengineering
Rates of visual field change and functional progression in glaucoma following trabecular microbypass implantation of iStent technologies: a meta-analysis
2024, BMJ Open Ophthalmology
Factors associated with pathologic myopia onset and progression: A systematic review and meta-analysis
2024, Ophthalmic and Physiological Optics

View all citing articles on Scopus

: Manuscript no. 2010-98.

: Financial Disclosure(s): The authors have made the following disclosures: C. S. Garudadri – Consultant – Allergan and Merck. Funding support by Hyderabad Eye Research Foundation.

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Original articleRelationship between Severity of Visual Field Loss at Presentation and Rate of Visual Field Progression in Glaucoma

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Methods

Results

Discussion

Surv Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Risk factors for primary open angle glaucoma progression: what we know and what we need to know

Curr Opin Ophthalmol

The Advanced Glaucoma Intervention Study (AGIS): 12Baseline risk factors for sustained loss of visual field and visual acuity in patients with advanced glaucoma

Am J Ophthalmol

Factors for glaucoma progression and the effect of treatment: the Early Manifest Glaucoma Trial

Arch Ophthalmol

Analysis of progressive change in automated visual fields in glaucoma

Invest Ophthalmol Vis Sci

Rate of visual field loss in progressive glaucoma

Arch Ophthalmol

Original article
Relationship between Severity of Visual Field Loss at Presentation and Rate of Visual Field Progression in Glaucoma