June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Incidence and risk factors for recurrent visual field progression in glaucoma
Author Affiliations & Notes
  • Alessandro A Jammal
    Ophthalmology, Duke University, Durham, North Carolina, United States
  • Tais Estrela
    Ophthalmology, Duke University, Durham, North Carolina, United States
  • Chris A Johnson
    Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Michael Wall
    Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Felipe Medeiros
    Ophthalmology, Duke University, Durham, North Carolina, United States
  • Footnotes
    Commercial Relationships   Alessandro Jammal None; Tais Estrela None; Chris Johnson None; Michael Wall None; Felipe Medeiros Allergan, Carl-Zeiss Meditec, Aeri Pharmaceuticals, Novartis, Biogen, Galimedix, Annexon, Stealth Biotherapeutics, Biozeus, Reichert, Idx, Code C (Consultant/Contractor), Carl-Zeiss Meditec, Heidelberg Engineering, Google, Reichert, Code F (Financial Support), NGoggle, Inc., Code P (Patent)
  • Footnotes
    Support  NEI EY029885 and EY031898
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 1282 – A0422. doi:
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      Alessandro A Jammal, Tais Estrela, Chris A Johnson, Michael Wall, Felipe Medeiros; Incidence and risk factors for recurrent visual field progression in glaucoma. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1282 – A0422.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To evaluate incidence and clinical characteristics of eyes that exhibit recurrent glaucomatous visual field progression during follow-up.

Methods : This study included 12,402 standard automated perimetry (SAP) tests of 1,070 eyes of 734 subjects from the Duke Glaucoma Registry (DGR). Eyes were followed for at least 5 years with a minimum of 7 reliable SAP 24-2 tests. Progression was determined by event-based analysis using the Guided Progression Analysis (GPA, Carl-Zeiss Meditec). At the time of each event of progression, the baseline visual field tests used for reference were reset and the GPA was subsequently reapplied until the end of follow-up. Similarly, risk factors such as mean and peak intraocular pressure (IOP) were revaluated to reflect each interval leading to the next event or end of follow-up. Survival analysis for recurrent events was used to evaluate risk factors for progression.

Results : Mean follow-up time was 8.5±2.9 years, with an average of 11.6±5.5 (range: 7 to 40) SAP tests per eye. A total of 375 events of progression occurred in the population during follow-up; 279 (26%) eyes had at least 1 event, of which 76 (27%) eyes presented a recurrence and 18 (6%) eyes presented a second recurrence. The cumulative probability of showing recurrent progression at 5 years was 13% and at 10 years was 63%. Eyes with recurrent progression tended to exhibit accelerated rates of progression in the interval leading to recurrence, with average rate of SAP MD of -0.45±0.17dB/year until the first event vs. -0.95±0.81dB/year between the first and the second event (P<0.001). Baseline MD (HR: 1.08; 95%CI: 1.05 to 1.12 per 1 dB lower; P<0.001), male gender (HR: 1.76; 95%CI: 1.05 to 2.95; P=0.033), and age (HR: 1.66; 95%CI 1.30 to 2.11 per decade older; P<0.001), were significantly associated with increased risk of recurrence in the multivariable analysis.

Conclusions : In this study with a large clinical population, approximately a quarter of eyes with glaucoma with a previous event of progression presented at least a second event during follow-up. The second episode of progression had, on average, faster rates of visual field loss than the first. Lower baseline MD, male gender, and older age were significant risk factors for recurrent progression.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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