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E. H. Leung, A. Tafreshi, P. A. Sample, L. M. Zangwill, R. N. Weinreb, F. A. Medeiros; Rates of Functional Loss in Eyes With Progressive Optic Disc Damage. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4904.
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To evaluate rates of functional loss as measured by standard automated perimetry (SAP) in eyes with progressive glaucomatous optic neuropathy (GON).
The study included 639 eyes of 407 glaucoma suspect patients recruited from the Diagnostic Innovations in Glaucoma Study (DIGS) and followed for an average of 8.0 years with annual standard automated perimetry visual field and optic disc stereophotographs. Glaucoma suspects had suspicious appearance of the optic disc at baseline and/or history of elevated intraocular pressure (>21mmHg). All patients had normal and reliable SAP results at baseline. Presence of progressive GON was evaluated by grading longitudinally acquired simultaneous stereophotographs. Rates of progressive functional loss were evaluated using the Visual Field Index (VFI) of SAP. Random coefficients models were used to evaluate rates of progressive visual field loss in eyes with evidence of progressive GON compared to eyes without evidence of structural deterioration over time. Best linear unbiased prediction (BLUP) was used to estimate rates of change for individual eyes.
Ninety-six eyes (15%) had progressive GON during the follow-up period. The average rate of VFI loss in eyes with progressive GON was significantly greater than in eyes without optic disc change during follow-up (-0.63%/year versus -0.14%/year, respectively; P<0.001). However, there was a large variability in the rates of functional deterioration in eyes with progressive GON, with rates of VFI change ranging from 0.02%/year to -9.2%/year.
Progressive glaucomatous optic neuropathy was associated with progressive functional deterioration. However, rates of functional loss were widely variable among eyes showing longitudinal evidence of structural change. Future studies will investigate risk factors for rapid structural or functional deterioration in glaucoma.
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