Glaucomatous Progression In Glaucoma Suspect Eyes

Abstract

Purpose : Early diagnosis and treatment of glaucoma is a significant factor in delaying vision loss. In this retrospective longitudinal study, we aimed to investigate the association of 5-year progression to glaucoma with early baseline visual field (VF) patterns and several demographic, clinical, VF test and optical coherence tomography (OCT) parameters in glaucoma suspect eyes.

Methods : We included glaucoma suspect eyes defined as a suspicious cup-to-disc ratio and/or high intraocular pressure (>21 mm Hg). We excluded eyes with glaucoma which were determined by at least two consecutive VF test results (24-2 SITA strategy; Humphrey® Field Analyzer) defined as glaucoma hemifield test results “outside normal limits” and/or a pattern standard deviation (PSD) with P value <0.05 regardless of the appearance of the optic disc. Reliability was defined as fixation loss <20%, and false positive and negative errors <15%. Different demographic, clinical, VF test and Cirrus OCT (Carl Zeiss Meditec, Dublin, CA) parameters were collected (Table 2). Baseline VF tests of patients were categorized as suspicious (meeting c, d and/or e criteria of the OHTS classification; Table 1) and normal (not meeting criteria c, d, or e of the OHTS classification); these VF patterns were reproduced in 2 consecutive reliable tests.

Results : 196 patients (265 eyes) with mean age of 60.22 ±11.28 years old were included. 21.47% of eyes with normal VF and 48.04% of eyes with suspicious VF pattern progressed to glaucoma after 5 years (p value<0.001). Bivariate analysis revealed that eyes with 5-year glaucomatous progression had statistically significantly older age (p=0.02), worse baseline BCVA (p=0.007; not clinically significant), higher percentage of the fellow eye diagnosed with glaucoma (p<0.001), more suspicious VF pattern (p<0.001), thinner overall RNFL (p=0.03), thinner superior RNFL (p<0.001) and worse baseline mean deviation (MD) (p<0.001) (Table 2). The other variables were statistically comparable between two groups (p>0.05 for all) (Table 2). The logistic regression model showed that only baseline MD and baseline VF pattern were significantly associated with 5-year progression of glaucoma.

Conclusions : We found early reproducible baseline VF pattern and baseline MD were statistically and clinically associated with 5-year progression to glaucoma in glaucoma suspect eyes. Early reproducible VF defects are significant for early detection of glaucoma and glaucoma progression.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.