March 2012
Volume 53, Issue 14
Free
ARVO Annual Meeting Abstract  |   March 2012
Examining Visual Field Loss In Patients With Glaucoma During Their Predicted Remaining Lifetime
Author Affiliations & Notes
  • David P. Crabb
    Optometry and Visual Science, City University London, London, United Kingdom
  • James F. Kirwan
    Ophthalmology, Queen Alexandra Hospital, Portsmouth, United Kingdom
  • Andrew I. McNaught
    Ophthalmology, Gloucestershire Eye Unit, Cheltenham, United Kingdom
  • David F. Garway-Heath
    NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Ananth C. Viswanathan
    NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Laurence D. Toms
    Ophthalmology, Queen Alexandra Hospital, Portsmouth, United Kingdom
  • Richard A. Russell
    Optometry and Visual Science, City University London, London, United Kingdom
  • Footnotes
    Commercial Relationships  David P. Crabb, None; James F. Kirwan, None; Andrew I. McNaught, None; David F. Garway-Heath, Carl Zeiss Meditec (F); Ananth C. Viswanathan, None; Laurence D. Toms, None; Richard A. Russell, None
  • Footnotes
    Support  Funded by the UK National Institute for Health Research (NIHR) Health Services Research programme (project number 10/2000/68).
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 2264. doi:https://doi.org/
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      David P. Crabb, James F. Kirwan, Andrew I. McNaught, David F. Garway-Heath, Ananth C. Viswanathan, Laurence D. Toms, Richard A. Russell; Examining Visual Field Loss In Patients With Glaucoma During Their Predicted Remaining Lifetime. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2264. doi: https://doi.org/.

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

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Abstract

Purpose: : To estimate visual field (VF) loss in patients during their predicted lifetime receiving standard clinical care in glaucoma clinics in England.

Methods: : Over 120,000 Humphrey 24-2 SITA VFs recorded in three regionally different glaucoma clinics/services in England (Cheltenham, London and Portsmouth) in the last decade were retrospectively investigated. A sample of patient VF series were considered, excluding those with too few VFs (less than 6) or insufficient follow-up (less than 3 years). Mean deviation (MD) at the baseline VF (‘diagnosis’) and MD loss during predicted remaining lifetime, using a linear rate of MD deterioration in dB/year and residual life expectancy tables, were calculated.

Results: : A sample of 4636 VF series from patients with a median age of 67 (interquartile range [IQR]: 58 to 73) years were analysed. For these VF series, median MD at ‘diagnosis’ was -2.8 dB (IQR: -6.9 to -0.8 dB) and median amount of further MD lost during predicted remaining lifetime was -2.4 dB (IQR: -6.1 to 0.0 dB). In the patient’s ‘better’ eye, median MD predicted to be lost during remaining lifetime was -2.0 dB (IQR: -5.8 to 0.0 dB). Seven percent (95% confidence interval: 6 to 8%) of patients were at risk of developing MD worse than -20 dB in the ‘better’ eye in their predicted remaining lifetime; MD in the ‘better’ eye in these patients at ‘diagnosis’ (median: -5.3 [IQR: -9.0 to -2.4] dB) was significantly different to the whole cohort (median: -1.8 [IQR: -4.0 to -0.4] dB; p<0.001).

Conclusions: : In this population, 50% of patients receiving standard clinical care are estimated to lose a total of less than 2 dB of MD in their ‘better’ eye during predicted lifetime after diagnosis; the average patient has lost more than half of all the VF they are destined to lose prior to diagnosis. A small but significant proportion of patients under clinical care, typically with worse MD at diagnosis, are estimated to be at risk of disabling VF loss during their predicted lifetime. These findings illuminate the need for earlier diagnosis in glaucoma.

Keywords: visual fields • clinical (human) or epidemiologic studies: health care delivery/economics/manpower • perimetry 
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