Abstract
Purpose :
To describe the location of initial visual field defects (VFD) in primary angle closure glaucoma (PACG), and the baseline factors that are associated with the different types of defect.
Methods :
In this clinic-based cross-sectional study, the initial visual fields of 289 PACG subjects were retrospectively analysed to identify pattern of VFD. The subjects were categorized into the following groups based on the initial VFD after excluding the first VF: (1) Normal (2) Nasal-partial arcuate (3) Central-paracentral (4) arcuate (5) bi-arcuate, and (5) advanced. The worse eye was defined as the eye with an earlier diagnosis of PACG, or worse glaucomatous optic neuropathy, and the contralateral fellow eye was considered the better eye.
Results :
The mean age at presentation of the 289 PACG subjects was 65.7±8.4 years and there were 139 (48.1%) females. Arcuate defect (88, 30.4%) and advanced visual field loss (89, 30.8%) were the most prevalent pattern of initial VFD in the worse eye. There were 24 (8.3%) normal, 15 (5.2%) with central-paracentral VFD, 39 (13.5%) nasal-partial arcuate, and 34 (11.8%) with bi-arcuate VFD. There were no significant differences in the mean age at presentation between the groups (ANOVA p=0.07). The intraocular pressure (IOP) at presentation was significantly highest in the bi-arcuate (31.1±13mmHg) and advanced (30.1±11.8mmHg) groups compared to the other groups (ANOVA p<0.001), and the visual acuity was significantly worse in the advanced group (p<0.001), with no significant differences observed between the other 5 groups (p>0.05 for all). The initial pattern of VFD was available for 246 (85.1%) fellow eyes, of which 41.4% (92 out of 222) were found to have normal VF in the fellow eye after excluding 24 subjects with normal VF in both eyes at presentation. Of the 70 advanced PACG with available fellow eye data, a total of 13 (18.6%) subjects also had an advanced defect in the fellow eye which constituted 5.3% (13 out of 246) of PACG who presented with bilateral advanced VFD.
Conclusions :
Whereas 40% of PACG subjects present with unilateral visual field loss, about a third presented with advanced VFD in at least one eye. The late presentation puts these individuals at a greater risk of blindness and necessitates the need for their early detection and treatment.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.