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Francisco A. Folgar, Gustavo V. De Moraes, Craig A. Liebmann, Robert Ritch, Jeffrey M. Liebmann; Visual Field Progression Outcomes in Glaucoma Subtypes. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5051.
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To determine whether glaucoma subtype is an independent risk factor for visual field (VF) progression.
We reviewed the charts of glaucoma suspects and glaucoma patients seen in a referral practice between 1999 and 2009. Automated pointwise linear regression analysis determined rates of VF change. A progression endpoint was determined when 2 or more adjacent test locations in the same hemifield showed a threshold sensitivity decline at a rate of ≥1.0 dB/yr with p<0.01.
We included 841 eyes (841 patients; mean age, 64.1±12.6 yrs; mean number of VF tests, 10.8±2.8; mean follow-up, 6.4±1.7 yrs). The glaucoma group consisted of angle-closure glaucoma (ACG, 76 eyes), juvenile primary open-angle glaucoma (JPOAG, 37 eyes), normal-tension glaucoma (NTG, 81 eyes), pigmentary glaucoma (PG, 34 eyes), primary open-angle glaucoma (POAG, 275 eyes), and exfoliative glaucoma (XFG, 84 eyes). NTG eyes were more likely to present with beta-zone parapapillary atrophy and disc hemorrhage (p<0.01). XFG eyes had the fastest rates of global VF change (-0.65 dB/yr), as well as the highest mean, fluctuation, and peak IOP during follow-up (16.5, 3.0, and 22.0 mmHg, respectively) and reached a progression endpoint more frequently (40%). After adjusting for all covariates, including the glaucoma phenotype, there was no difference among groups regarding global rates of VF change and the risk of reaching a progression endpoint.
Despite different clinical features, epidemiology and genetics, glaucoma phenotype is not an independent risk factor for VF progression. Rather, variations in well-known, reported risk factors remain important disease parameters that affect progression.
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