Abstract
Abstract: :
Purpose: We have recently explored risk factors associated with visual field (VF) progression in the Advanced Glaucoma Intervention Study (AGIS) with pointwise linear regression (PLR). The purpose of this investigation is to evaluate predictive factors for VF progression and to explore evidence for establishing a target pressure. Methods: We selected 509 eyes (401 patients) from AGIS with 3 or more years of follow–up, a minimum of 7 visual fields and an AGIS reference score of 16 or better. Visual field status was evaluated at yearly intervals with PLR. VF progression was defined as worsening of at least 2 test locations within a Glaucoma Hemifield Test cluster confirmed in two subsequent PLR analyses. Cox proportional hazard regression model was used to assess risk factors for VF progression and to seek evidence for an interaction between IOP and baseline VF status. Results: Visual field progression was detected in 210 eyes (41%). Older age at the onset of the study (p <0.001, HR = 1.30), increasing number of glaucoma interventions (p <0.001, HR = 1.64), male gender (p = 0.019, HR = 1.29), the TAT intervention sequence (p = 0.02, HR = 1.42), greater IOP fluctuation (p = 0.023, HR = 1.10), and a better baseline mean defect (p = 0.03, HR = 1.14) were associated with increased odds of VF progression. The IOP effect on VF progression was not related to baseline VF damage (no significant interaction between IOP and baseline VF status, p = 0.08). Conclusions: No convincing evidence for establishing a target pressure based on the baseline VF damage was found. Older age and IOP fluctuation were confirmed to be important risk factors for VF progression.
Keywords: clinical (human) or epidemiologic studies: risk factor assessment • intraocular pressure • visual fields