April 2016
Volume 57, Issue 4
Open Access
Glaucoma  |   April 2016
Evaluation of Glaucoma Progression in Large-Scale Clinical Data: The Japanese Archive of Multicentral Databases in Glaucoma (JAMDIG)
Author Affiliations & Notes
  • Yuri Fujino
    Department of Ophthalmology The University of Tokyo, Tokyo, Japan
  • Ryo Asaoka
    Department of Ophthalmology The University of Tokyo, Tokyo, Japan
  • Hiroshi Murata
    Department of Ophthalmology The University of Tokyo, Tokyo, Japan
  • Atsuya Miki
    Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
  • Masaki Tanito
    Department of Ophthalmology, Shimane University Faculty of Medicine, Shimane, Japan
    Division of Ophthalmology, Matsue Red Cross Hospital, Shimane, Japan
  • Shiro Mizoue
    Department of Ophthalmology, Ehime University Graduate School of Medicine, Ehime, Japan
  • Kazuhiko Mori
    Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
  • Katsuyoshi Suzuki
    Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
  • Takehiro Yamashita
    Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
  • Kenji Kashiwagi
    Department of Ophthalmology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
  • Nobuyuki Shoji
    Orthoptics and Visual Science, Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
  • Correspondence: Ryo Asaoka, Department of Ophthalmology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan; rasaoka-tky@umin.ac.jp
Investigative Ophthalmology & Visual Science April 2016, Vol.57, 2012-2020. doi:10.1167/iovs.15-19046
  • Views
  • PDF
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to Subscribers Only
      Sign In or Create an Account ×
    • Get Citation

      Yuri Fujino, Ryo Asaoka, Hiroshi Murata, Atsuya Miki, Masaki Tanito, Shiro Mizoue, Kazuhiko Mori, Katsuyoshi Suzuki, Takehiro Yamashita, Kenji Kashiwagi, Nobuyuki Shoji, on behalf of the Japanese Archive of Multicentral Databases in Glaucoma (JAMDIG) Construction Group; Evaluation of Glaucoma Progression in Large-Scale Clinical Data: The Japanese Archive of Multicentral Databases in Glaucoma (JAMDIG). Invest. Ophthalmol. Vis. Sci. 2016;57(4):2012-2020. doi: 10.1167/iovs.15-19046.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
Abstract

Purpose: To develop a large-scale real clinical database of glaucoma (Japanese Archive of Multicentral Databases in Glaucoma: JAMDIG) and to investigate the effect of treatment.

Methods: The study included a total of 1348 eyes of 805 primary open-angle glaucoma patients with 10 visual fields (VFs) measured with 24-2 or 30-2 Humphrey Field Analyzer (HFA) and intraocular pressure (IOP) records in 10 institutes in Japan. Those with 10 reliable VFs were further identified (638 eyes of 417 patients). Mean total deviation (mTD) of the 52 test points in the 24-2 HFA VF was calculated, and the relationship between mTD progression rate and seven variables (age, mTD of baseline VF, average IOP, standard deviation (SD) of IOP, previous argon/selective laser trabeculoplasties (ALT/SLT), previous trabeculectomy, and previous trabeculotomy) was analyzed.

Results: The mTD in the initial VF was −6.9 ± 6.2 dB and the mTD progression rate was −0.26 ± 0.46 dB/year. Mean IOP during the follow-up period was 13.5 ± 2.2 mm Hg. Age and SD of IOP were related to mTD progression rate. However, in eyes with average IOP below 15 and also 13 mm Hg, only age and baseline VF mTD were related to mTD progression rate.

Conclusions: Age and the degree of VF damage were related to future progression. Average IOP was not related to the progression rate; however, fluctuation of IOP was associated with faster progression, although this was not the case when average IOP was below 15 mm Hg.

Glaucoma is one of the leading causes of blindness in the world.1,2 The disease is a progressive and irreversible optic neuropathy that can result in irrevocable visual field (VF) damage. Primary open-angle glaucoma (POAG) is the most common type, affecting more than 45 million people, with prevalence rates reported between 0.5% and 8.8%322 that increase with age.23 The prevalence of normal-tension glaucoma (NTG) is in the region of 0.17% to 0.67% worldwide4,14,1719,2427; however, a population-based epidemiologic study revealed an exceptionally high prevalence (3.6%) of NTG in the Japanese population.28 Previous studies have reported that reducing intraocular pressure (IOP) is helpful in preventing glaucomatous VF progression,2931 but it has also been reported that approximately 20% of patients with NTG experience VF progression despite a 30% reduction in IOP.30 
Reduction of IOP is applied as a principal treatment in glaucoma, supported by many randomized controlled trial (RCT) studies2933; however, the generalizability (external validity) of RCTs may be limited because patients, providers, and concurrent care in the general population are often very different from those involved in the RCT.3436 Indeed, previous studies have revealed different outcomes in preventing glaucomatous VF progression, in particular related with race.37,38 Hence, it is clinically very important to also investigate the efficacy of IOP reduction treatment in a real and large-scale clinical dataset. This has become achievable thanks to the growing usage of the electronic medical record systems in Japan. Thus, the first purpose of the current study was to develop a large-scale real clinical database of glaucoma outcomes in Japanese patients (Japanese Archive of Multicentral Databases in Glaucoma: JAMDIG), and the second purpose of the current study was to investigate the effect of treatment in the dataset. 
Subjects and Methods
The review board of each institute reviewed and approved all protocols. The studies complied with the tenets of the Declaration of Helsinki. Written consent was given by patients for their information to be stored in the hospital database and used for research; otherwise, based on the regulations of the Japanese Guidelines for Epidemiologic Study 2008 issued by the Japanese Government, the study protocols did not require that each patient provide written informed consent. Instead the protocol was posted at the outpatient clinic to notify participants of the study. 
Data Collection
All of the data collected in the current study (JAMDIG) were obtained from ten institutes in Japan as listed in the appendix. Using the electronic records of each institute, all patients with POAG, including NTG, who satisfied the following criteria were identified retrospectively: (1) Glaucoma was the only disease causing VF damage; (2) each patient had at least 11 VF measurements with 24-2 or 30-2 Humphrey Field Analyzer II (HFA) (Carl Zeiss Meditec, Inc., Dublin, CA, USA) and at least 10 IOP measurements with Goldmann applanation tonometry. Primary open-angle glaucoma was defined as (1) presence of typical glaucomatous changes in the optic nerve head such as a rim notch with a rim width ≤ 0.1 disc diameters or a vertical cup-to-disc ratio of >0.7 and/or a retinal nerve fiber layer defect with its edge at the optic nerve head margin greater than a major retinal vessel, diverging in an arcuate or wedge shape; and (2) gonioscopically wide open angles of grade 3 or 4 based on the Shaffer classification. Exclusion criterion were age below 20 years and possible secondary ocular hypertension in either eye. 
From the medical record, a history of surgical/laser treatments was collected. Surgical treatment was categorized into two groups: surgeries associated with the creation of bleb using mitomycin-C (trabeculectomy and nonpenetrating trabeculectomy; trabeculectomy group) and other procedures (trabeculotomy and viscocanalostomy; trabeculotomy group). Each of these categories included both glaucoma surgery alone and combined glaucoma and cataract surgery. Laser treatment consisted of argon and selective laser trabeculoplasties (ALT/SLT group). 
Data Filtering
Reliable VFs were defined as fixation loss (FL) rate < 20% and also false-positive (FP) rate < 15% following the criteria used by the HFA software; false negative (FN) was not used as an exclusion criterion. Reliable VFs were identified, and eyes with at least 11 reliable VFs were collected. Eyes that experienced any surgical procedure, including needling bleb revision and neodymium: yttrium aluminum garnet (YAG) capsulotomy, during this period were carefully excluded. Removing the baseline VF, the remaining 10 VFs for each eye were used to measure progression. We chose a minimum of 10 VFs because it has recently been reported that this volume is needed to precisely analyze VF progression.39 In the data collection phase, other clinical information such as central corneal thickness (CCT), general medical past history, history of smoking, and significant family history was also collected but not used in the current analysis due to a large proportion of missing values. Data from eyes with exfoliation glaucoma were initially collected but were excluded from the current analysis because of the very small number of eyes (13 in total). 
Statistical Analysis
First, mean total deviation (mTD) of the 52 test points in the 24-2 HFA VF was calculated. Then, the progression rate of mTD was calculated using the 10 VFs collected from each eye with linear regression against time, similarly to the MD trend analysis employed in the HFA. As both eyes of a patient tend to progress similarly, a mixed linear regression model was employed to investigate mTD progression; in this model the eyes of a patient are nested within the patient. The average and standard deviation (SD) of IOP measurements were also calculated. These summary statistics, as well as mTD progression rate, were compared between eyes with previous trabeculectomy and other procedures. 
The relationship between mTD progression rate and seven variables (age at the baseline VF measurement, mTD value of the baseline VF, average IOP, SD of IOP, previous ALT/SLT, previous trabeculectomy, and previous trabeculotomy) was analyzed using linear mixed modeling, whereby patients were treated as a random effect. The optimal linear model was selected using the second-order bias corrected Akaike Information Criterion (AICc) index. The AIC is a well-known statistical measure used in model selection, and the AICc is a corrected version of the statistic, which provides an accurate estimation even when the sample size is small.40 In a multivariate regression model, the degrees of freedom decreases with a large number of variables, and it is therefore recommended to use model selection methods to improve the model fit by removing redundant variables.41,42 In the current study, model selection was performed from seven variables, which corresponds to 27 choices of linear model. This calculation was performed using all eyes and also in two subgroups of patients whose average IOP fell below 15 and 13 mm Hg. 
All analyses were performed using the statistical programming language R (R version 3.1.3; Foundation for Statistical Computing, Vienna, Austria). 
Results
In the initial collecting phase, 1348 eyes of 805 POAG patients were identified between January 1997 and January 2015. Following the filtering process, 710 eyes of 490 patients were removed for the following reasons: 448 eyes had fewer than 11 reliable VFs; 78 eyes had fewer than 10 IOP measurements during the follow-up period, and 184 eyes underwent surgical treatment or YAG laser capsulotomy during the follow-up period. As a result, 638 eyes of 417 patients remained in the analysis. As shown in Table 1, the mean (±SD) age of patients was 54.8 ± 11.8 years, ranging from 21 to 84 years. The 10 VFs analyzed were obtained over 5.4 ± 1.1 [range, 2.1–9.4] years and IOP measurements were carried out 23.6 ± 6.0 [10–43] (mean ± SD [range]) times per eye. The VFs were measured over an interval of 198.0 ± 42.6 [74.7–344.2] days while IOP was measured over an interval of 89.5 ± 31.3 [27.9–248.7] days. The mTD value in the initial VF was −6.9 ± 6.2 [−26.8 to 2.8] dB, and the mTD progression rate was −0.26 ± 0.46 [−2.6 to 1.4] dB/year (Fig. 1). Mean IOP during the follow-up period was 13.5 ± 2.2 [5.6–21.8] mm Hg (Fig. 2). Among the 638 eyes, 37 eyes of 34 patients had trabeculectomy prior to the baseline VF, and 12 eyes of 10 patients had trabeculotomy prior to the baseline VF. Among these 12 eyes, all patients had trabeculectomy following trabeculotomy and prior to the baseline VF (see Table 2). Fifty-one eyes of 48 patients had ALT/SLT treatment prior to the baseline VF. Forty-two eyes of 38 patients had ALT/SLT treatment during the follow-up period. 
Figure 1
 
Histogram of mTD progression rate. mTD progression rate was −0.26 ± 0.46 [−2.6 to 1.4] dB/year. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field.
Figure 1
 
Histogram of mTD progression rate. mTD progression rate was −0.26 ± 0.46 [−2.6 to 1.4] dB/year. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field.
Figure 2
 
Histogram of mean IOP. Mean IOP was 13.5 ± 2.2 [5.6–21.8] (mean ± SD [range]) mm Hg. IOP, intraocular pressure.
Figure 2
 
Histogram of mean IOP. Mean IOP was 13.5 ± 2.2 [5.6–21.8] (mean ± SD [range]) mm Hg. IOP, intraocular pressure.
Table 1
 
Subject Demographics of the Data Analyzed
Table 1
 
Subject Demographics of the Data Analyzed
Table 2
 
Demographic Data of Initial Data, Exclusion Reasons, and Treatment History in the Final Data Analyzed
Table 2
 
Demographic Data of Initial Data, Exclusion Reasons, and Treatment History in the Final Data Analyzed
Mean IOP was significantly lower in eyes with previous trabeculectomy than in others (11.7 ± 3.2 [5.6–18.9] and 13.6 ± 2.1 [8.4–21.8] mm Hg, respectively, P < 0.001, linear mixed model). In contrast, there was not a significant difference between the SD of IOP in these eyes (1.7 ± 0.6 [0.8–4.4] and 1.6 ± 0.6 [0.70–6.9], respectively, P = 0.70, linear mixed model). As shown in Figure 3, there was not a significant difference between the mTD progression rates in these eyes (−0.31 ± 0.50 [−2.3 to 0.56] and −0.26 ± 0.46 [−2.6 to 1.4] dB/year, respectively, P = 0.71, linear mixed model). 
Figure 3
 
Comparison of mTD progression rates with and without previous trabeculectomy. There was not a significant difference between the mTD progression rate with and without previous trabeculectomy. The box represents first and third quartile with median value, and error bars represent outside 1.5 times the interquartile range above the upper quartile and below the lower quartile mTD: mean of 52 total deviation values corresponding to 24-2 Humphrey visual field.
Figure 3
 
Comparison of mTD progression rates with and without previous trabeculectomy. There was not a significant difference between the mTD progression rate with and without previous trabeculectomy. The box represents first and third quartile with median value, and error bars represent outside 1.5 times the interquartile range above the upper quartile and below the lower quartile mTD: mean of 52 total deviation values corresponding to 24-2 Humphrey visual field.
Figure 4 illustrates the relationship between mTD progression rate and age. There was a significant relationship between these parameters (mTD progression rate = 0.051 − 0.0058*age, P = 0.0014 for age, linear mixed model). There was not a significant relationship between mTD progression rate and mTD in the baseline VF (P = 0.16, linear mixed model; Fig. 5). The mTD progression rate was not significantly related to average IOP (P = 0.32, linear mixed model; Fig. 6), but significantly related to the SD of IOP (mTD progression rate = −0.13 − 0.084*SD of IOP, P = 0.011 for SD of IOP, linear mixed model; Fig. 7). 
Figure 4
 
The relationship between mTD progression rate and age at the baseline VF. There was a significant relationship between these parameters (mTD progression rate = 0.051 − 0.0058*age, P = 0.0014 for age, linear mixed model). Figure plotted as a smoothed scatter plot. VF, visual field; mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field.
Figure 4
 
The relationship between mTD progression rate and age at the baseline VF. There was a significant relationship between these parameters (mTD progression rate = 0.051 − 0.0058*age, P = 0.0014 for age, linear mixed model). Figure plotted as a smoothed scatter plot. VF, visual field; mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field.
Figure 5
 
The relationship between mTD progression rate and mTD in the baseline VF. There was not a significant relationship between mTD progression rate and mTD in the baseline VF (P = 0.16, linear mixed model). Figure 5 was plotted as a smoothed scatter plot. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field; VF, visual field.
Figure 5
 
The relationship between mTD progression rate and mTD in the baseline VF. There was not a significant relationship between mTD progression rate and mTD in the baseline VF (P = 0.16, linear mixed model). Figure 5 was plotted as a smoothed scatter plot. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field; VF, visual field.
Figure 6
 
The relationship between mTD progression rate and mean IOP. There was no significant relationship between mTD progression rate and mean IOP (P = 0.32, linear mixed model). Figure 6 was plotted as a smoothed scatter plot. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field; IOP, intraocular pressure.
Figure 6
 
The relationship between mTD progression rate and mean IOP. There was no significant relationship between mTD progression rate and mean IOP (P = 0.32, linear mixed model). Figure 6 was plotted as a smoothed scatter plot. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field; IOP, intraocular pressure.
Figure 7
 
The relationship between mTD progression rate and SD of IOP. There was a significant relationship between mTD progression rate and SD of IOP (mTD progression rate = −0.13 − 0.084*SD of IOP, P = 0.011 for SD of IOP, linear mixed model). Figure 7 was plotted as a smoothed scatter plot. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field; SD, standard deviation; IOP, intraocular pressure.
Figure 7
 
The relationship between mTD progression rate and SD of IOP. There was a significant relationship between mTD progression rate and SD of IOP (mTD progression rate = −0.13 − 0.084*SD of IOP, P = 0.011 for SD of IOP, linear mixed model). Figure 7 was plotted as a smoothed scatter plot. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field; SD, standard deviation; IOP, intraocular pressure.
As a result of model selection using AICc, the optimal linear model for mTD progression rate was given by: mTD progression rate = 0.16 − 0.0055*age at the baseline VF measurement −0.077*SD of IOP; thus, mTD of the baseline VF, average IOP, previous trabeculectomy, previous trabeculotomy, and previous ALT/SLT were not included (see Table 3). 
Table 3
 
Results of Optimal Linear Model Obtained by AICc Model Selection
Table 3
 
Results of Optimal Linear Model Obtained by AICc Model Selection
Among the 638 eyes, 485 eyes of 320 patients had an average IOP below 15 mm Hg, whereby 33 eyes of 30 patients had previous trabeculectomy, 10 eyes of 9 patients had previous trabeculotomy, and 36 eyes of 28 patients had previous ALT/SLT. In this average IOP < 15 mm Hg group, the mTD progression rate was −0.26 ± 0.45 [−2.6 to 1.1] (mean ± SD [range]) dB/year and the optimal linear model for the mTD progression rate was: mTD progression rate = 0.039 − 0.0046*age at the baseline VF measurement + 0.0057*mTD of the baseline VF; average IOP, SD of IOP, previous trabeculectomy, previous trabeculotomy, and previous ALT/SLT were not included (Table 3). Similarly, 271 eyes of 187 patients had an average IOP below 13 mm Hg, whereby 22 eyes of 20 patients had previous trabeculectomy, 5 eyes of 5 patients had previous trabeculotomy, and 16 eyes of 15 patients had previous ALT/SLT. In this average IOP < 13 mm Hg group, the mTD progression rate was −0.25 ± 0.42 [−1.8 to 0.81] (mean ± SD [range]) dB/year and the optimal linear model for the mTD progression rate was: mTD progression rate = 0.10 − 0.0052*age at the baseline VF measurement + 0.0073*mTD of the baseline VF; average IOP, SD of IOP, previous trabeculectomy, previous trabeculotomy, and previous ALT/SLT were not included (Table 3). 
Discussion
Large-scale real clinical data were collected from ten centers in Japan. Data from 1348 eyes of 805 patients with open-angle glaucoma were collected. Among this dataset, 638 eyes from 417 patients with POAG were analyzed in the current study. It was observed that IOP was significantly lower in eyes with previous trabeculectomy; however, the SD of IOP measurements was not significantly different between groups. Similarly, mTD progression rate was not significantly different between eyes with and without previous trabeculectomy. Among the clinical parameters of age, mTD value in the baseline VF, ALT/SLT, previous trabeculectomy, previous trabeculotomy, and average IOP and SD of IOP, it was suggested that only age and SD of IOP were related to the mTD progression rate. A subgroup analysis using only eyes with an average IOP below 15 or 13 mm Hg revealed that only age and mTD value in the baseline VF were related to mTD progression rate. 
The mean VF progression rate in the current study was −0.26 dB/year with a mean IOP of 13.5 mm Hg. Some recent comparable studies have reported the rates of VF progression using data obtained at real clinics. Heijl et al.43 reported a VF progression rate of −0.80 dB/year with a mean IOP between 18.1 and 20.2 mm Hg, obtained from 583 patients with open-angle glaucoma. De Moraes et al.44 reported a −0.45 dB/year VF progression rate with a mean IOP of 15.2 mm Hg, obtained from 587 patients with glaucoma. Our results suggest slower VF progression rates with lower IOP levels than observed in other reports. 
It is of interest to compare the current results with a previous RCT in normal-tension glaucomatous eyes that provides natural history progression rate: The Collaborative Normal-Tension Glaucoma Study Group reported mean rates of approximately −0.4 dB/year.45 The VF progression rate in the current study is very similar to that in a previous observational study (−0.25 dB/year) based on 34 posttrabeculectomy patients with a maximum IOP of 12 mm Hg (mean: 10.3 mm Hg) and a follow-up of at least 3 years.46 
Age is an established risk factor for the progression of glaucoma.4752 In agreement with this, age was selected in the optimal model with a negative coefficient (the older the patient, the faster progression). It is worth noting, however, that clinicians would tend to choose less aggressive treatments in elderly patients. Thus, the significant effect of age on the progression rate could be attributed, at least partially, to this treatment selection bias. Nevertheless, these two parameters were also selected in the subanalyses with eyes in which IOP was controlled at a low level; hence it is suggested that age is still a risk factor for progression, beyond any treatment selection bias. 
Many previous studies have suggested that VF damage at baseline is a risk factor for progression.47,50,52 In agreement with this, the mTD at baseline parameter was selected in the optimal model with a positive coefficient (the worse the mTD values, the faster progression) in eyes with low IOP (mean < 15 mm Hg); however, this parameter was not related to progression in the analysis using all eyes and instead, SD of IOP was related. Thus VF damage at baseline was related to progression rate only when mean IOP was below 15 mm Hg. 
Many previous studies31,33,47,5360 have made it known, beyond doubt, that high IOP is a risk factor for the progression of glaucoma. Interestingly, in the current study, average IOP was not significantly related to mTD progression rate (Fig. 6), and it was not included in any of the optimal linear models. This result should be attributed to the difference in the study designs. In the current study, all data were collected in a retrospective manner. As a result, eyes deemed to be at high risk of progression tended to be treated with intensive treatments such as trabeculotomy, ALT/SLT, or even trabeculectomy. Thus, the current results do not deny the efficacy of these treatments, in particular for eyes with a high risk of progression. In turn, it could be suggested that current treatment strategies (in the Japanese institutes contributing data to this study) are successfully preventing the progression of glaucoma associated with average IOP. 
The effect of variation in IOP on the progression of glaucoma is controversial.6164 In the current study, SD of IOP was significantly related to progression rate in the analysis using all eyes. As discussed above, the current data are “biased” by the treatment selection of clinicians. As a result, IOP reduction was generally well controlled in our data, as is often seen in clinical settings, in terms of the average value. Nonetheless, our results suggest that VF progression is associated with high variation in IOP. Clinicians should advise patients regarding the importance of treatment compliance because there is no doubt that this is directly related to the variance of IOP.56,65 The importance of IOP variation was not observed when average IOP was lower than 15 mm Hg. 
It has been reported that trabeculectomy is associated with a reduction in IOP fluctuation between visits or postural change,6670 which could reduce the progression of VF damage. Nonetheless, our current results suggest that IOP fluctuation/variation following trabeculectomy was no different from values in nonoperated eyes. The reason for these contradictory results is unclear, but again could be attributed to a difference in study design; previous studies estimated IOP fluctuation within a very short period, such as following postural change or over a 24-hour period, whereas the current study estimated fluctuation over a much longer follow-up period. On the other hand, SD of IOP was significantly related to the progression rate, so consideration should be given to the fluctuation of IOP, irrespective of the history of trabeculectomy, when clinicians make treatment decisions. 
In Japan, trabeculotomy is frequently performed in adults with glaucoma.7173 This bleb-independent glaucoma surgery is often performed when glaucoma is not in an advanced stage and preoperative IOP is not too high (usually below 30 mm Hg); otherwise trabeculectomy tends to be performed. In the current analysis, previous trabeculotomy was not related to the progression rate. However, it is not appropriate to draw conclusions about the effect of trabeculotomy on future VF progression based on the current results because of the limited number of eyes (n = 12). Furthermore, all among the 12 eyes had trabeculectomy after trabeculotomy, prior to the baseline VF; hence further study should be carried out to shed light on the effect of trabeculotomy on the progression of VF damage. The effect of another treatment option, ALT/SLT, on VF progression was also assessed, but a significant relationship was not observed. We included eyes with ALT/SLT during the observation period because ALT/SLT usually does not have a significant effect on the VF. In contrast, trabeculectomy and trabeculotomy often will affect patients' VFs. We carried out model selection again in which eyes that had undergone ALT/SLT (42 eyes) were dropped from the data. Similarly, we also performed model selection in eyes with average IOP < 15 mm Hg, and also eyes with average IOP < 13 mm Hg. As a consequence, very similar results were obtained: The same parameters were selected with very similar coefficient values, with just one exception. The SD of IOP was selected instead of mTD of the baseline VF in eyes with IOP < 15 mm Hg (results not presented in this paper). 
There are a number of limitations to the current study. A possible caveat is the exclusion of central corneal thickness CCT as a clinical parameter; CCT is closely related to measured IOP with Goldmann tonometry7478 and also the progression of glaucoma.48,79 Further efforts should be made to collect real-world clinical data on VF progression with accompanying CCT measurements. The current study did not include eyes with exfoliation, which tend to have high fluctuations in IOP often associated with rapid VF progression.63,80,81 Progression of glaucoma is associated with the status of myopia; however, refractive error and axial length were not collected in all patients in the current study and so this information could not be included in the analyses. These measurements should be included in future data collection. In addition, surgical treatment, in particular trabeculectomy, is often associated with complications that affect visual function, such as bleb-related infection.82,83 The effect of these possible complications was not fully considered in the current study because of the lack of data prior to surgery. In particular, eyes with severe damage to their visual function cannot undergo VF measurements and so were not assessed in the current study. Thus, careful consideration is warranted when one is interpreting the current results, particularly when making treatment decisions. 
Most importantly, it should be noted that all data in the current study came from subjects who had 11 VF measurements at university or major city hospitals over a 2- to 9-year period. We chose eyes with 11 VFs because we have recently shown that this amount of VF data is required to accurately estimate VF progression.39 In these Japanese settings, it is not rare to follow patients from an early stage through to surgical/laser treatment. Indeed, nine eyes of nine patients had trabeculectomy after the 11th VF measurement (528.3 ± 701.8 [range, 19–2304]: mean ± SD [range] days from the 11th VF measurement), five eyes of five patients had trabeculotomy after the 11th VF measurement (625.6 ± 358.5 [range, 232–2953] days from the 11th VF measurement), and three eyes of two patients had ALT/SLT after the 11th VF measurement (520.7 ± 761.5 [range, 81–1400] days from the 11th VF measurement). However, we would like to emphasize that the current results largely represent the VF changes observed in a well-controlled and mostly stable glaucoma population, since eyes that had surgical or laser treatment between the first and 11th VF were excluded from the analysis. Thus, particularly careful consideration is needed when extrapolating the results of this study to other glaucoma populations. 
In conclusion, we have shown that age and the degree of VF damage are related to future progression. History of previous trabeculectomy and average IOP were not related to the progression rate; however, fluctuation of IOP was associated with faster progression, although this was not the case in a subgroup of eyes with average IOP below 15 mm Hg. 
Acknowledgments
Supported in part by Grant 26462679 (RA) from the Ministry of Education, Culture, Sports, Science and Technology of Japan and Japan Science and Technology Agency (JST) CREST (RA). 
Disclosure: Y. Fujino, None; R. Asaoka, None; H. Murata, None; A. Miki, None; M. Tanito, None; S. Mizoue, None; K. Mori, None; K. Suzuki, None; T. Yamashita, None; K. Kashiwagi, None; N. Shoji 
References
Quigley HA. Number of people with glaucoma worldwide. Br J Ophthalmol. 1996; 80: 389–393.
Congdon N, O'Colmain B, Klaver CC, et al.; Eye Diseases Prevalence Research Group. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol. 2004; 122: 477–485.
Shiose Y, Kitazawa Y, Tsukahara S, et al. Epidemiology of glaucoma in Japan--a nationwide glaucoma survey. Jpn J Ophthalmol. 1991; 35: 133–155.
Foster PJ, Oen FT, Machin D, et al. The prevalence of glaucoma in Chinese residents of Singapore: a cross-sectional population survey of the Tanjong Pagar district. Arch Ophthalmol. 2000; 118: 1105–1111.
Leske MC, Connell AM, Schachat AP, Hyman L. The Barbados Eye Study. Prevalence of open angle glaucoma. Arch Ophthalmol. 1994; 112: 821–829.
Cedrone C, Culasso F, Cesareo M, Zapelloni A, Cedrone P, Cerulli L. Prevalence of glaucoma in Ponza, Italy: a comparison with other studies. Ophthalmic Epidemiol. 1997; 4: 59–72.
Bonomi L, Marchini G, Marraffa M, et al. Prevalence of glaucoma and intraocular pressure distribution in a defined population. The Egna-Neumarkt Study. Ophthalmology. 1998; 105: 209–215.
Buhrmann RR, Quigley HA, Barron Y, West SK, Oliva MS, Mmbaga BB. Prevalence of glaucoma in a rural East African population. Invest Ophthalmol Vis Sci. 2000; 41: 40–48.
Wensor MD, McCarty CA, Stanislavsky YL, Livingston PM, Taylor HR. The prevalence of glaucoma in the Melbourne Visual Impairment Project. Ophthalmology. 1998; 105: 733–739.
Quigley HA, West SK, Rodriguez J, Munoz B, Klein R, Snyder R. The prevalence of glaucoma in a population-based study of Hispanic subjects: Proyecto VER. Arch Ophthalmol. 2001; 119: 1819–1826.
Rotchford AP, Johnson GJ. Glaucoma in Zulus: a population-based cross-sectional survey in a rural district in South Africa. Arch Ophthalmol. 2002; 120: 471–478.
Tielsch JM, Sommer A, Katz J, Royall RM, Quigley HA, Javitt J. Racial variations in the prevalence of primary open-angle glaucoma. The Baltimore Eye Survey. JAMA. 1991; 266: 369–374.
Sommer A, Tielsch JM, Katz J, et al. Racial differences in the cause-specific prevalence of blindness in east Baltimore. N Engl J Med. 1991; 325: 1412–1417.
Leibowitz HM, Krueger DE, Maunder LR, et al. The Framingham Eye Study monograph: an ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973-1975. Surv Ophthalmol. 1980; 24: 335–610.
Mason RP, Kosoko O, Wilson MR, et al. National survey of the prevalence and risk factors of glaucoma in St. Lucia, West Indies. Part I. Prevalence findings. Ophthalmology. 1989; 96: 1363–1368.
Sommer A, Tielsch JM, Katz J, et al. Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans. The Baltimore Eye Survey. Arch Ophthalmol. 1991; 109: 1090–1095.
Klein BE, Klein R, Sponsel WE, et al. Prevalence of glaucoma. The Beaver Dam Eye Study. Ophthalmology. 1992; 99: 1499–1504.
Dandona L, Dandona R, Srinivas M, et al. Open-angle glaucoma in an urban population in southern India: the Andhra Pradesh eye disease study. Ophthalmology. 2000; 107: 1702–1709.
Dielemans I, Vingerling JR, Wolfs RC, Hofman A, Grobbee DE, de Jong PT. The prevalence of primary open-angle glaucoma in a population-based study in The Netherlands. The Rotterdam Study. Ophthalmology. 1994; 101: 1851–1855.
Wolfs RC, Borger PH, Ramrattan RS, et al. Changing views on open-angle glaucoma: definitions and prevalences--The Rotterdam Study. Invest Ophthalmol Vis Sci. 2000; 41: 3309–3321.
Mitchell P, Smith W, Attebo K, Healey PR. Prevalence of open-angle glaucoma in Australia. The Blue Mountains Eye Study. Ophthalmology. 1996; 103: 1661–1669.
Foster PJ, Baasanhu J, Alsbirk PH, Munkhbayar D, Uranchimeg D, Johnson GJ. Glaucoma in Mongolia. A population-based survey in Hovsgol province, northern Mongolia. Arch Ophthalmol. 1996; 114: 1235–1241.
Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006; 90: 262–267.
Hollows FC, Graham PA. Intra-ocular pressure, glaucoma, and glaucoma suspects in a defined population. Br J Ophthalmol. 1966; 50: 570–586.
Bankes JL, Perkins ES, Tsolakis S, Wright JE. Bedford glaucoma survey. Br Med J. 1968; 1: 791–796.
Bengtsson B. The prevalence of glaucoma. Br J Ophthalmol. 1981; 65: 46–49.
Kozobolis VP, Detorakis ET, Tsilimbaris M, Siganos DS, Vlachonikolis IG, Pallikaris IG. Crete, Greece glaucoma study. J Glaucoma. 2000; 9: 143–149.
Iwase A, Suzuki Y, Araie M, et al.; Tajimi Study Group, Japan Glaucoma Society. The prevalence of primary open-angle glaucoma in Japanese: the Tajimi Study. Ophthalmology. 2004; 111: 1641–1648.
Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002; 120: 701–713, discussion 829–830.
The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma. Collaborative Normal-Tension Glaucoma Study Group. Am J Ophthalmol. 1998; 126: 498–505.
Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M;, Early Manifest Glaucoma Trial Group. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol. 2002; 120: 1268–1279.
Ederer F, Gaasterland DE, Sullivan EK;, Agis Investigators. The Advanced Glaucoma Intervention Study (AGIS): 1. Study design and methods and baseline characteristics of study patients. Control Clin Trials. 1994; 15: 299–325.
Garway-Heath DF, Crabb DP, Bunce C, et al. Latanoprost for open-angle glaucoma (UKGTS): a randomised, multicentre, placebo-controlled trial. Lancet. 2015; 385: 1295–1304.
Booth CM, Tannock IF. Randomised controlled trials and population-based observational research: partners in the evolution of medical evidence. Br J Cancer. 2014; 110: 551–555.
Dans AL, Dans LF, Guyatt GH, Richardson S. Users' guides to the medical literature: XIV. How to decide on the applicability of clinical trial results to your patient. Evidence-Based Medicine Working Group. JAMA. 1998; 279: 545–549.
Meyer RM. Generalizing the results of cancer clinical trials. J Clin Oncol. 2010; 28: 187–189.
Ederer F, Gaasterland DA, Dally LG, et al. The Advanced Glaucoma Intervention Study (AGIS): 13. Comparison of treatment outcomes within race: 10-year results. Ophthalmology. 2004; 111: 651–664.
Investigators. AGIS, The Advanced Glaucoma Intervention Study (AGIS): 9. Comparison of glaucoma outcomes in black and white patients within treatment groups. Am J Ophthalmol. 2001; 132: 311–320.
Taketani Y, Murata H, Fujino Y, Mayama C, Asaoka R. How many visual fields are required to precisely predict future test results in glaucoma patients when using different trend analyses? Invest Ophthalmol Vis Sci. 2015; 56: 4076–4082.
Burnham KP, Anderson D. Multimodel inference: understanding AIC and BIC in model selection. Sociol Methods Res. 2004; 33: 261–304.
Tibshirani RJ, Taylor J. Degrees of freedom in lasso problems. Ann Stat. 2012; 40: 1198–1232.
Mallows C. Some comments on Cp. Technometrics. 1973; 15: 661–675.
Heijl A, Buchholz P, Norrgren G, Bengtsson B. Rates of visual field progression in clinical glaucoma care. Acta Ophthalmol. 2013; 91: 406–412.
De Moraes CG, Juthani VJ, Liebmann JM, et al. Risk factors for visual field progression in treated glaucoma. Arch Ophthalmol. 2011; 129: 562–568.
Anderson DR, Drance SM, Schulzer M;, Collaborative Normal-Tension Glaucoma Study Group. Natural history of normal-tension glaucoma. Ophthalmology. 2001; 108: 247–253.
Araie M. Basic and clinical studies of pressure-independent damaging factors of open angle glaucoma [in Japanese]. Nippon Ganka Gakkai Zasshi. 2011; 115: 213–236 discussion 237.
Leske MC, Heijl A, Hyman L, Bengtsson B, Dong L, Yang Z;, EMGT Group. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology. 2007; 114: 1965–1972.
Gordon MO, Beiser JA, Brandt JD, et al. The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002; 120: 714–720, discussion 829–830.
European Glaucoma Prevention Study (EGPS) Group, Miglior S, Pfeiffer N, Torri V, Zeyen T, Cunha-Vaz J, Adamsons I. Predictive factors for open-angle glaucoma among patients with ocular hypertension in the European Glaucoma Prevention Study. Ophthalmology. 2007; 114: 3–9.
Lichter PR, Musch DC, Gillespie BW, et al.; CIGTS Study Group. Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology. 2001; 108: 1943–1953.
De Moraes CG, Sehi M, Greenfield DS, Chung YS, Ritch R, Liebmann JM. A validated risk calculator to assess risk and rate of visual field progression in treated glaucoma patients. Invest Ophthalmol Vis Sci. 2012; 53: 2702–2707.
Lee JM, Caprioli J, Nouri-Mahdavi K, et al. Baseline prognostic factors predict rapid visual field deterioration in glaucoma. Invest Ophthalmol Vis Sci. 2014; 55: 2228–2236.
Holmin C, Thorburn W, Krakau CE. Treatment versus no treatment in chronic open angle glaucoma. Acta Ophthalmol (Copenh). 1988; 66: 170–173.
Pajic B, Pajic-Eggspuehler B, Hafliger IO. Comparison of the effects of dorzolamide/timolol and latanoprost/timolol fixed combinations upon intraocular pressure and progression of visual field damage in primary open-angle glaucoma. Curr Med Res Opin. 2010; 26: 2213–2219.
Krupin T, Liebmann JM, Greenfield DS, Ritch R, Gardiner S;, Low-Pressure Glaucoma Study Group. A randomized trial of brimonidine versus timolol in preserving visual function: results from the Low-Pressure Glaucoma Treatment Study. Am J Ophthalmol. 2011; 151: 671–681.
Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Collaborative Normal-Tension Glaucoma Study Group. Am J Ophthalmol. 1998; 126: 487–497.
Migdal C, Gregory W, Hitchings R. Long-term functional outcome after early surgery compared with laser and medicine in open-angle glaucoma. Ophthalmology. 1994; 101: 1651–1656 discussion 1657.
Jay JL, Murray SB. Early trabeculectomy versus conventional management in primary open angle glaucoma. Br J Ophthalmol. 1988; 72: 881–889.
Musch DC, Gillespie BW, Lichter PR, Niziol LM, Janz NK;, CIGTS Study Investigators. Visual field progression in the Collaborative Initial Glaucoma Treatment Study the impact of treatment and other baseline factors. Ophthalmology. 2009; 116: 200–207.
The Advanced Glaucoma Intervention Study (AGIS). 7. The relationship between control of intraocular pressure and visual field deterioration. The AGIS Investigators. Am J Ophthalmol. 2000; 130: 429–440.
Musch DC, Gillespie BW, Niziol LM, Lichter PR, Varma R;, and for the CIGTS Study Group. Intraocular pressure control and long-term visual field loss in the Collaborative Initial Glaucoma Treatment Study. Ophthalmology. 2011; 118: 1766–1773.
Caprioli J, Coleman AL. Intraocular pressure fluctuation a risk factor for visual field progression at low intraocular pressures in the advanced glaucoma intervention study. Ophthalmology. 2008; 115: 1123–1129, e1123.
Bengtsson B, Leske MC, Hyman L, Heijl A;, Early Manifest Glaucoma Trial Group. Fluctuation of intraocular pressure and glaucoma progression in the early manifest glaucoma trial. Ophthalmology. 2007; 114: 205–209.
Varma R, Hwang LJ, Grunden JW, Bean GW. Inter-visit intraocular pressure range: an alternative parameter for assessing intraocular pressure control in clinical trials. Am J Ophthalmol. 2008; 145: 336–342.
Stewart WC, Chorak RP, Hunt HH, Sethuraman G. Factors associated with visual loss in patients with advanced glaucomatous changes in the optic nerve head. Am J Ophthalmol. 1993; 116: 176–181.
Medeiros FA, Pinheiro A, Moura FC, Leal BC, Susanna R,Jr. Intraocular pressure fluctuations in medical versus surgically treated glaucomatous patients. J Ocul Pharmacol Ther. 2002; 18: 489–498.
Konstas AG, Topouzis F, Leliopoulou O, et al. 24-hour intraocular pressure control with maximum medical therapy compared with surgery in patients with advanced open-angle glaucoma. Ophthalmology. 2006; 113: 761–765, e761.
Hirooka K, Takenaka H, Baba T, Takagishi M, Mizote M, Shiraga F. Effect of trabeculectomy on intraocular pressure fluctuation with postural change in eyes with open-angle glaucoma. J Glaucoma. 2009; 18: 689–691.
Weizer JS, Goyal A, Ple-Plakon P, et al. Bleb morphology characteristics and effect on positional intraocular pressure variation. Ophthal Surg Lasers Imaging. 2010; 41: 532–537.
Sawada A, Yamamoto T. Effects of trabeculectomy on posture-induced intraocular pressure changes over time. Graefes Arch Clin Exp Ophthalmol. 2012; 250: 1361–1366.
Tanihara H, Negi A, Akimoto M, et al. Surgical effects of trabeculotomy ab externo on adult eyes with primary open angle glaucoma and pseudoexfoliation syndrome. Arch Ophthalmol. 1993; 111: 1653–1661.
Tanihara H, Negi A, Akimoto M, Nagata M. Long-term surgical results of combined trabeculotomy ab externo and cataract extraction. Ophthalmic Surg. 1995; 26: 316–324.
Nakasato H, Uemoto R, Isozaki M, Meguro A, Kawagoe T, Mizuki N. Trabeculotomy ab interno with internal limiting membrane forceps for open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol. 2014; 252: 977–982.
Whitacre MM, Stein R. Sources of error with use of Goldmann-type tonometers. Surv Ophthalmol. 1993; 38: 1–30.
Goldmann H, Schmidt T. Applanation tonometry [in German]. Ophthalmologica. 1957; 134: 221–242.
Kotecha A, White ET, Shewry JM, Garway-Heath DF. The relative effects of corneal thickness and age on Goldmann applanation tonometry and dynamic contour tonometry. Br J Ophthalmol. 2005; 89: 1572–1575.
Whitacre MM, Stein RA, Hassanein K. The effect of corneal thickness on applanation tonometry. Am J Ophthalmol. 1993; 115: 592–596.
Feltgen N, Leifert D, Funk J. Correlation between central corneal thickness applanation tonometry, and direct intracameral IOP readings. Br J Ophthalmol. 2001; 85: 85–87.
Jonas JB, Holbach L. Central corneal thickness and thickness of the lamina cribrosa in human eyes. Invest Ophthalmol Vis Sci. 2005; 46: 1275–1279.
Heijl A, Bengtsson B, Hyman L, Leske MC;, Early Manifest Glaucoma Trial Group. Natural history of open-angle glaucoma. Ophthalmology. 2009; 116: 2271–2276.
Konstas AG, Mantziris DA, Stewart WC. Diurnal intraocular pressure in untreated exfoliation and primary open-angle glaucoma. Arch Ophthalmol. 1997; 115: 182–185.
Yamada H, Sawada A, Kuwayama Y, Yamamoto T. Blindness following bleb-related infection in open angle glaucoma. Jpn J Ophthalmol. 2014; 58: 490–495.
Yamamoto T, Sawada A, Mayama C, et al.; Collaborative Bleb-Related Infection Incidence and Treatment Study Group. The 5-year incidence of bleb-related infection and its risk factors after filtering surgeries with adjunctive mitomycin C: collaborative bleb-related infection incidence and treatment study 2. Ophthalmology. 2014; 121: 1001–1006.
Footnotes
 Study Group: See the appendix for the members of the JAMDIG Construction Group.
Appendix
JAMDIG Centers and Investigators: Participating Institutions and Investigators
Study Co-Chairman: Nobuyuki Shoji, medical doctor [MD] 
Clinical Centers
Department of Ophthalmology, The University of Tokyo, Tokyo, Japan: Ryo Asaoka, medical doctor; Yuri Fujino, orthoptist; Masato Matsuura, orthoptist; Mieko Yanagisawa, orthoptist; Hiroyo Hirasawa, MD; Hiroshi Murata, MD; Chihiro Mayama, MD. 
Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan: Atsuya Miki, MD; Shinichi Usui, MD; Kenji Matsushita, MD; Kohji Nishida, MD. 
Department of Ophthalmology, Shimane University Faculty of Medicine, Shimane, Japan: Masaki Tanito, MD; Tetsuro Omura, orthoptist. 
Department of Ophthalmology, Ehime University Graduate School of Medicine, Ehime, Japan: Shiro Mizoue, MD. 
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan: Kazuhiko Mori, MD; Yoko Ikeda, MD; Hiromi Yamada, administration staff. 
Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan: Katsuyoshi Suzuki, MD; Shinichiro Teranishi, MD; Rie Shiraishi, MD; Masaaki Kobayashi, MD; Manami Ohta, MD; Tadahiko Ogata, MD. 
Department of Ophthalmology, Kagoshima University, Graduate School of Medical and Dental Sciences, Kagoshima, Japan: Takehiro Yamashita, MD. 
Department of Ophthalmology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan: Kenji Kashiwagi, MD; Fumihiko Mabuchi, MD. 
Orthoptics and Visual Science, Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan: Nobuyuki Shoji, MD; Kazunori Hirasawa, orthoptist. 
Operations and Steering Committee: Ryo Asaoka, MD; Atsuya Miki, MD; Masaki Tanito, MD; Shiro Mizoue, MD; Kazuhiko Mori, MD; Katsuyoshi Suzuki, MD; Kenji Kashiwagi, MD; Takehiro Yamashita, MD; Nobuyuki Shoji, MD. 
Figure 1
 
Histogram of mTD progression rate. mTD progression rate was −0.26 ± 0.46 [−2.6 to 1.4] dB/year. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field.
Figure 1
 
Histogram of mTD progression rate. mTD progression rate was −0.26 ± 0.46 [−2.6 to 1.4] dB/year. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field.
Figure 2
 
Histogram of mean IOP. Mean IOP was 13.5 ± 2.2 [5.6–21.8] (mean ± SD [range]) mm Hg. IOP, intraocular pressure.
Figure 2
 
Histogram of mean IOP. Mean IOP was 13.5 ± 2.2 [5.6–21.8] (mean ± SD [range]) mm Hg. IOP, intraocular pressure.
Figure 3
 
Comparison of mTD progression rates with and without previous trabeculectomy. There was not a significant difference between the mTD progression rate with and without previous trabeculectomy. The box represents first and third quartile with median value, and error bars represent outside 1.5 times the interquartile range above the upper quartile and below the lower quartile mTD: mean of 52 total deviation values corresponding to 24-2 Humphrey visual field.
Figure 3
 
Comparison of mTD progression rates with and without previous trabeculectomy. There was not a significant difference between the mTD progression rate with and without previous trabeculectomy. The box represents first and third quartile with median value, and error bars represent outside 1.5 times the interquartile range above the upper quartile and below the lower quartile mTD: mean of 52 total deviation values corresponding to 24-2 Humphrey visual field.
Figure 4
 
The relationship between mTD progression rate and age at the baseline VF. There was a significant relationship between these parameters (mTD progression rate = 0.051 − 0.0058*age, P = 0.0014 for age, linear mixed model). Figure plotted as a smoothed scatter plot. VF, visual field; mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field.
Figure 4
 
The relationship between mTD progression rate and age at the baseline VF. There was a significant relationship between these parameters (mTD progression rate = 0.051 − 0.0058*age, P = 0.0014 for age, linear mixed model). Figure plotted as a smoothed scatter plot. VF, visual field; mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field.
Figure 5
 
The relationship between mTD progression rate and mTD in the baseline VF. There was not a significant relationship between mTD progression rate and mTD in the baseline VF (P = 0.16, linear mixed model). Figure 5 was plotted as a smoothed scatter plot. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field; VF, visual field.
Figure 5
 
The relationship between mTD progression rate and mTD in the baseline VF. There was not a significant relationship between mTD progression rate and mTD in the baseline VF (P = 0.16, linear mixed model). Figure 5 was plotted as a smoothed scatter plot. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field; VF, visual field.
Figure 6
 
The relationship between mTD progression rate and mean IOP. There was no significant relationship between mTD progression rate and mean IOP (P = 0.32, linear mixed model). Figure 6 was plotted as a smoothed scatter plot. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field; IOP, intraocular pressure.
Figure 6
 
The relationship between mTD progression rate and mean IOP. There was no significant relationship between mTD progression rate and mean IOP (P = 0.32, linear mixed model). Figure 6 was plotted as a smoothed scatter plot. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field; IOP, intraocular pressure.
Figure 7
 
The relationship between mTD progression rate and SD of IOP. There was a significant relationship between mTD progression rate and SD of IOP (mTD progression rate = −0.13 − 0.084*SD of IOP, P = 0.011 for SD of IOP, linear mixed model). Figure 7 was plotted as a smoothed scatter plot. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field; SD, standard deviation; IOP, intraocular pressure.
Figure 7
 
The relationship between mTD progression rate and SD of IOP. There was a significant relationship between mTD progression rate and SD of IOP (mTD progression rate = −0.13 − 0.084*SD of IOP, P = 0.011 for SD of IOP, linear mixed model). Figure 7 was plotted as a smoothed scatter plot. mTD, mean of 52 total deviation values corresponding to 24-2 Humphrey visual field; SD, standard deviation; IOP, intraocular pressure.
Table 1
 
Subject Demographics of the Data Analyzed
Table 1
 
Subject Demographics of the Data Analyzed
Table 2
 
Demographic Data of Initial Data, Exclusion Reasons, and Treatment History in the Final Data Analyzed
Table 2
 
Demographic Data of Initial Data, Exclusion Reasons, and Treatment History in the Final Data Analyzed
Table 3
 
Results of Optimal Linear Model Obtained by AICc Model Selection
Table 3
 
Results of Optimal Linear Model Obtained by AICc Model Selection
×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×