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John Mark de Leon, Desmond Quek, Hla Htoon, Ecosse Lamoureux, Tin Aung; Persistence of Glaucoma Therapy and Visual Field Progression. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3961.
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To determine the longitudinal association of visual field (VF) progression with persistency in a cohort of patients who were commenced on glaucoma medical therapy.
Pharmacy records were examined retrospectively for patients who commenced glaucoma mono-therapy from October 2005 to September 2006 until 3 years later (Quek DTL et al, Arch Ophthalmol 2011). A patient was defined as persistent over this sample period if he/she had refilled the prescription for the same medication < 90 days after the previous prescription had lapsed. For this study, only patients with > 5 reliable VF data (SITA 24-2, Carl Zeiss Meditec, Dublin, CA) over the next few years were included. VF progression was analysed using point-wise linear regression (Progressor, Medisoft, Ltd, Leeds, U.K.) and defined using two criteria: (a) > 2 adjacent progressing points (slope p<0.01) in one hemi-field and (b) > 3 progressing points (slope p<0.01) (adjacent or non-adjacent). The mean number of progressing points; and the average slopes of progressing points and the entire VF were also determined.
320 persistent (PS) and 2461 non-persistent (NP) patients were identified. After excluding eyes with < 5 reliable VF data, 140 eligible patients (28 PS and 112 NP) were studied. The majority of patients in both groups were Chinese and there was no inter-group difference for mean age (63.7 + 13.5 and 59.9 + 11.1 years for PS and NP respectively; p=0.13). The mean follow-up periods were 54.8 + 7.8 vs. 53.3 + 11.5 months (p=0.9) for the PS and NP groups respectively. Overall, there were 1/28 (3.6%) and 12/112 (10.7%) subjects who progressed in the PS and NP groups (p=0.47) using criterion A; and 1/28 (3.6%) and 11/112 (9.82%, p=0.46) using criterion B. The mean number of progressing points (0.32 + 0.19 vs. 0.73 + 0.17, p=0.27), the average slope of progressing points (-0.33 + 0.82 vs. -0.80 + 1.47dB/yr. p=0.11) and the average slope of the entire VF (0.12 vs. -0.2dB/yr. p=0.4) were similar for both groups. A multivariate model, adjusted for age and gender, showed that the slope of progressing points was associated with non-persistence (p=0.04).
There were small but appreciable differences in VF progression rates between PS and NP glaucoma subjects. Non-persistent patients were more likely to have steeper progression of visual field points.
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