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Johnny Xiang Li, Carlos G DeMoraes, Noga Harizman, Ari Leshno, Qing Wang, George A Cioffi, Jeffrey M Liebmann; Comparison of Global and Hemifield Rates of Visual Field (VF) Progression in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1274 – A0414.
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© ARVO (1962-2015); The Authors (2016-present)
To compare VF hemifield vs. global mean deviation (MD) rates of progression.
Eyes with ≥10 VF tests (Swedish Interactive Thresholding Algorithm 24-2) and ≥3 years of follow-up were included from patients at Columbia University Irving Medical Center. Rates of progression (dB/yr) in global, superior, and inferior hemifield mean deviation were calculated. The presence of rapid (worse than -0.5 dB/year), very rapid (worse than -1.0 dB/year), and catastrophic (worse than -2.0 dB/year) progression were determined.
VFs from 4,217 eyes (average number of tests, 15.0; mean follow up, 9.3 years) of 2,435 patients were included. The rate of change in global, superior hemifield, and inferior hemifield MD were statistically different among all three groups (-0.30dB/year vs. -0.31 dB/year vs. -0.28 dB/year, respectively, p < 0.01) (Table 1). In the superior hemifield, a larger percentage of patients demonstrated rapid progression (26.9% vs. 25.4%), very rapid progression (11.0% vs. 8.7%), and catastrophic progression (2.0% vs. 1.2%) compared to global mean deviation. A similar result was seen in the inferior hemifield but only in those that demonstrated catastrophic progression (1.7% vs. 1.2%). Comparing symmetry of progression between the superior and inferior hemifield (Figure 1), although a plurality of eyes (82.1%) had minimal difference between hemifield change (superior minus inferior hemifield slopes between 0.0 and -0.5 dB/year), a substantial percentage of patients had asymmetry between the hemifields, with 17.9% of eyes having a difference greater than -0.5 dB/year and 5.5% greater than -1.0 dB/year.
Superior, inferior, and global VF MD rates of progression often differ, but a large difference may serve as an indicator for rapidly progressing glaucoma and necessitate a treatment change or earlier surgical intervention. Identification of these areas of regional, rapid progression can be used to individualize management and treatment decisions.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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