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V. T. Koh, D. T. Quek, T. Aung; Long-Term Progression of Visual Field Defects in Patients With Primary Angle Closure Glaucoma Treated at one Singapore Hospital. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3996.
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To investigate the long-term progression of visual field (VF) defects in treated primary angle closure glaucoma (PACG) patients based on the Advanced Glaucoma Intervention Study (AGIS) scoring system.
Consecutive PACG patients presenting at a Singapore hospital with a follow-up duration of at least 10 years were retrospectively analyzed. All Humphrey visual fields (HVF, central 24-2 threshold test) performed during the follow-up period were reviewed and only reliable fields (fixation losses <20%, false positives and false negatives <33%) were scored using the AGIS system. Asymmetry in severity of VF defect was defined as an inter-ocular score difference of more than 4. Progression of a VF defect was defined as a score change of more than 4 from baseline on 2 consecutive HVF tests.
A total of 116 eyes of 69 subjects (56.5% female, 98.6% Chinese, mean age 62.3 years) were included. On average, each subject had 14±4.5 HVF tests over 10.5±2.4 years, 69.2% of which were reliable. At baseline, the mean AGIS score was 9.25±7.10 (moderate severity) and 43.2% of patients exhibited inter-ocular asymmetry. The mean score for the worse eye was 12.1±6.8 (severe) compared to 5.9±6.5 (moderate) in the fellow eye (p<0.001). Over the follow-up period, 43.9% of eyes were treated with topical anti-hypertensive medication, 67.2% had laser iridotomy and 79.3% had undergone glaucoma surgery. VF progression was detected in only 12 eyes (10.3%) of 10 patients, with a mean progression score of 6.2±2.2 over 7.2±3.6 years. Comparing patients who progressed with those that did not, there was no significant difference in age, gender, severity of baseline VF defect or type of treatment.
PACG patients frequently present with VF defects of moderate severity and significant inter-ocular asymmetry. Over a 10-year period, only a small proportion of hospital-treated patients progressed in severity of VF defects
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