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Carlos G. De Moraes, Sung Chul Park, Christopher C. Teng, Celso Tello, Julia Nemiroff, Robert Ritch, Jeffrey M. Liebmann; Glaucomatous Optic Disc Changes Predict More Rapid Rates of Visual Field Progression in Treated Patients. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4140.
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To investigate the relationship between optic disc progression and rates of visual field (VF) change in patients with treated, established glaucoma.
Glaucoma patients with repeatable VF loss, ≥8 SITA-Standard 24-2 VFs, and good quality stereophotographs evaluated over a 10-year period were included. Optic disc photos were reviewed by two glaucoma specialists masked to their temporal sequence. Disagreements were adjudicated by a third grader. Optic disc progression was defined when 2 out of 3 graders called progression and accurately determined the temporal sequence of photos. VF progression was evaluated using automated pointwise linear regression (PLR). VF progression was defined as at least 2 adjacent test points progressing >1.0 dB/yr at p<0.01. VF progression outcomes were compared with adjudicated photograph review results.
389 eyes (389 patients; mean age 64.9±13.0 yrs; mean baseline MD, -7.1±5.1) were included. Eyes with documented optic disc change progressed more rapidly than stable eyes (-0.66±0.7 vs. -0.36±0.7 dB/yr, p<0.01) and reached a VF PLR endpoint more often (OR=1.80, p=0.02). Optic disc photography had a good performance to detect rapid VF progression (AUC=0.64, p<0.01). There was moderate agreement between the location where optic disc change occurred and the hemifield with most rapid VF progression (81%, kappa=0.40).
A topographic change in the appearance of the optic disc in eyes with established glaucoma is associated with more rapid VF progression. .Eyes with documented optic disc progression are at increased risk of presenting more rapid decay of visual function over time and may require more aggressive therapy to prevent future vision loss.
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