April 2010
Volume 51, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2010
Rates of Visual Field Progression in Patients Under Glaucoma Care
Author Affiliations & Notes
  • J. Schmidt
    Ophthalmology, Catholic University of Chile, Santiago, Chile
  • E. Abusleme
    Ophthalmology, Catholic University of Chile, Santiago, Chile
  • S. Araneda
    Ophthalmology, Catholic University of Chile, Santiago, Chile
  • P. Laso
    Ophthalmology, Catholic University of Chile, Santiago, Chile
  • E. Maul D.
    Ophthalmology, Catholic University of Chile, Santiago, Chile
  • Footnotes
    Commercial Relationships  J. Schmidt, None; E. Abusleme, None; S. Araneda, None; P. Laso, None; E. Maul D., None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science April 2010, Vol.51, 3999. doi:
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    • Get Citation

      J. Schmidt, E. Abusleme, S. Araneda, P. Laso, E. Maul D.; Rates of Visual Field Progression in Patients Under Glaucoma Care. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3999.

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

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Abstract

Purpose: : To study the visual field (VF) features and determine the VF progression (VFP) in open angle glaucoma patients treated in the Glaucoma Department, in a University Medical Center.

Methods: : We performed a retrospective chart review of patients diagnosed with Primary Open Angle Glaucoma (POAG) who had at least 5 Sita Standard 24-2 VF tests during the study period. VFP was determined by three criteria: 1) Change in the VF defect 2) Progression of Mean Defect (MD) ≥ -0.8 dB/year (dB/y), and 3) Glaucoma progression analysis (GPA) with statistically significant negative slope (GPA analysis of Humphrey Perimetry).

Results: : Ninety-nine eyes of 71 patients were included. Mean age was 71 years, mean follow up time was 60.5 months, mean number of VF was 7.9. The mean initial MD was -7.7 dB and the mean final MD was -9.4 dB for the whole cohort. Forty-nine eyes (49.5%) progressed in the study period. Criteria 1 was observed in 23 eyes (23.2%), criteria 2 was observed in 23 eyes (23.2%) and criteria 3 was observed in 33 eyes (33.3%). Twenty eyes progressed according to 1 of three criteria, 28 eyes according to 2 of 3 criteria, and 1 eye met all criteria. The rate of VFP of the whole cohort was -0.37 dB/y. Fast progressors (at least 1 eye with ≥ -0.8 dB/y) were 23 patients (32.4%). VFP in dB/y of eyes with criteria 3 was -1.02 dB/y (significantly higher than the whole cohort, p< 0.05).

Conclusions: : Three different progression criteria were evaluated in the study. The change in VF defect was not effective to detect patients at risk of visual impairment. Indeed, 32.4% of this apparently well controlled group of patients were fast progressors. Patients with significant GPA had a higher rate of VFP in dB/y. Determination of the VFP rate in glaucoma care is a challenge in our daily clinical practice. Many patients do progress, but only some of them threatening their visual function. Identifying the fast progressors represents a priority and a new paradigm in decisions for a change in treatment to avoid glaucoma blindness. A priority for treatment objective should be to determine the VFP rate early after diagnosis to identify fast progressors and submit them to a more aggressive treatment.

Keywords: perimetry • clinical (human) or epidemiologic studies: risk factor assessment • visual fields 
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