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I. Forchheimer, C. G. De Moraes, F. A. Folgar, C. C. Teng, C. Tello, R. Ritch, J. M. Liebmann; Intraocular Pressure, Baseline Visual Field (VF) Mean Deviation (MD), and Glaucoma Progression. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4022.
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To evaluate the relationships between VF baseline MD, IOP, and subsequent VF progression in treated glaucoma patients.
The charts of all patients seen in a glaucoma referral practice between 1999 and 2009 were reviewed. One eye of subjects with ≥8 SITA-Standard 24-2 VF and baseline VF damage were included (Group A, MD better than -4.20 dB; Group B, MD between -4.21 and -8.17 dB; Group C, worse than -8.17 dB) Patients with other ocular conditions known to affect the VF or insufficient number of VF to create a slope were excluded. Automated pointwise linear regression determined global and localized rates (dB/yr) of change. Progression was defined 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.
587 patients (587 eyes; mean age, 64.9±13.0; mean number of VF tests; 11.1±3.0; mean follow-up time, 6.4±1.7 yrs) were enrolled (Group A, n=196; Group B, 195; Group C, 196). For Groups A, B, and C respectively, progression was noted in 30.1%, 31.8%, and 26% of eyes (p=0.43) and global rates of VF change of progressing eyes were -1.3±1.2, -1.01±0.7, and -0.9±0.5 dB/yr (p=0.09). For Groups A, B, and C respectively, IOPs in the stable vs progressing eyes were 15.5±3.3 vs 17.0±3.1 (P<0.01), 15.4±3.3 vs 15.9±2.5 (P=0.28), and 14.0±2.8 vs 14.8±2.3 mmHg (P=0.07). More glaucoma filtering surgeries were performed in eyes with worse MD (Group A, 46; Group B, 73; Group C, 87; p<0.01). Even though there was a weak but significant trend suggesting that eyes with worse MD progressed more slowly (Pearson’s r=-0.08, p=0.03), this association became non-significant after adjusting for the mean follow-up IOP (p=0.37). For Group A, B, and C eyes, respectively, progression occurred in 17%, 17% and 14% at mean IOP ≤12 mmHg, 24%, 32% and 24% at IOP ≤18 mmHg, and 44%, 32% and 50% at IOP>18 mmHg.
In treated glaucoma, the rate of VF progression is independent of the severity of the baseline VF MD which could be related to the aggressiveness of treatment. Eyes with lower IOP tend to progress less frequently across the spectrum of VF loss.
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