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Namita Bhardwaj, Philip I. Niles, David S. Greenfield, Maggie B. Hymowitz, Mitra Sehi, William J. Feuer, Donald L. Budenz; The Impact of Surgical Intraocular Pressure Reduction on Visual Function Using Various Criteria to Define Visual Field Progression. Invest. Ophthalmol. Vis. Sci. 2012;53(14):262.
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© ARVO (1962-2015); The Authors (2016-present)
To examine the impact of surgical Intraocular pressure (IOP) reduction on visual function using various methods to define visual field (VF) progression.
A retrospective chart review was conducted on consecutive glaucoma patients who underwent surgical IOP reduction between January 1, 2002 and December 31, 2007. All subjects had glaucomatous optic neuropathy, a minimum of 5 preoperative and 5 postoperative visual fields, and were followed for a minimum of 2 years both before and after surgery. VF progression was determined using Guided Progression Analysis (GPA), linear regression analysis of the visual-field index (VFI), and individual sensitivity values using Progressor software.
Seventeen eyes of 17 patients (mean age 77.9 ± 9.9 years) were enrolled. Subjects were followed for a mean 5.8 +/- 2.4 years prior to surgery and 4.5 ± 1.5 years following surgery. Mean postoperative IOP (11.3 ± 4.2mmHg) and medications (1.3 ± 1.3) were significantly (p<0.001 and p=0.01) reduced compared with prior to surgery (18.0 ± 3.9mmHg, 2.4 ± 0.9 respectively). The number of eyes judged to have VF progression using any method during the postoperative period (3 of 17, 17.6%) was significantly (p=0.03) reduced compared to the preoperative period (9 of 17 eyes, 52.9%). Using VFI criteria, 8 eyes were judged to have preoperative VF progression and 1 eye had persistent VF progression during the postoperative period. None of the eyes judged to have preoperative VF progression using EMGT (n=4) and Progressor criteria (n=1) demonstrated persistent VF progression during the postoperative period. Among eyes with preoperative VF progression, the postoperative slope of mean deviation (-0.21 ± 0.23 db/yr) was significantly (p=0.03) reduced compared with prior to surgery (-1.01 ± 0.23 db/yr).
Despite differences in the criteria used to define visual field progression, glaucoma surgical IOP reduction significantly reduces the incidence and rate of visual field progression.
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