Abstract
Purpose :
To determine the visual field (VF) rates of change among patients with glaucomatous patterns of VF loss and those who will become blind based on residual life expectancy as well as the factors associated with a fast rate of progression and blindness at expected death.
Methods :
This was a retrospective study of the VF series of patients with glaucomatous patterns VF defects in at least one eye in a tertiary hospital in the Philippines. VF data were recorded and reviewed. Rates of VF change, calculated in decibels (dB) per year for each eye, together with the residual life expectancy based on age and sex were used to predict the mean deviation or defect (MD) at the end of a patient’s expected lifetime. A patient was considered blind if the computed MD reached a value of 22 dB (Octopus®) or -22 dB (Humphrey®) or worse in the better eye. Factors associated with a fast rate of progression (>1 dB/year for Octopus® or <-1 dB/year for Humphrey®) and blindness were also established.
Results :
1016 eyes of 583 patients were eligible for this study. Overall, 613/1016 (60.3%), 95% CI [57.3%,63.3%] of eyes showed a decline in VF MD per year, however, only 98/1016 (9.7%), 95% CI [7.9%,11.5%] of eyes showed fast progression. Among patients with VF series in both eyes, 43/433 (9.9%), 95% CI [7.11,12.75] were predicted to progress to blindness in their expected lifetime. In multivariate analysis, factors associated with a fast rate of progression were the baseline MD (p<0.001) and male sex (p=0.041) whereas those associated with blindness at death were age <60 years (p=0.003), baseline MD (p=0.022), presence glaucomatous VF defect pattern on both eyes (p=<0.001), and a fast rate of progression (p<0.001).
Conclusions :
Less than 10% of patients will reach blindness in their expected lifetime under a routine clinical setting. Because of the association of age and baseline MD on blindness, the valuable role of early disease detection is underscored. VF progression rates as well as the individual’s residual life expectancy should be incorporated in glaucoma care to determine whether treatment should be escalated in order to prevent blindness.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.