Abstract
Purpose :
To assess whether longitudinal changes in central visual field increase the risk of visual acuity (VA) loss in patients with Primary Open Angle Glaucoma (POAG).
Methods :
VA loss was defined as a loss of 0.2 logarithm of the minimum angle of resolution (logMAR) or more in 2 consecutive exams. The mean value of the 4 innermost paracentral point locations from the total deviation (TD) plot of a 24-2 standard automated perimetry (SAP) test, threat to fixation area (TTF), was calculated and a joint longitudinal survival models were used to evaluate the rates of changes in the TTF area for predicting VA loss over time, adjusting for confounding variables, such SAP mean deviation (MD), age and central corneal thickness (CCT) at baseline, and intraocular pressure (IOP) measurement during follow-up. A separated analysis was performed in a subgroup that included only pseudophakic eyes.
Results :
This study included 4,131 SAP tests and 17,704 clinical visits of 1,207 eyes of 900 POAG patients followed for an average of 4.0 ± 3.2 years. The rates of change of paracentral points in TD plot were significantly predictive of VA loss with an increase of 2.6-times the risk of developing VA loss for each 1 dB/year decrease in the slope (HR 2.56, CI, 1.73, 3.82; P < 0.001), after adjusting for age, SAP MD and CCT at baseline, and for IOP measurements during follow-up. The risk for VA loss was also higher for the pseudophakic eyes. For this group, rates of change on mean TD of the 4 central points were associated with VA loss with a HR of 4.63 (95% CI:2.38, 8.93; P < 0.001) the multivariable analysis.
Conclusions :
In our study longitudinal changes on the mean of 4 central points from SAP TD was predictive of development of VA loss in glaucoma patients and should be included in the assessment of risk for visual impairment.
This is a 2021 ARVO Annual Meeting abstract.