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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)
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.
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).
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).
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.
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