Vascular and non-vascular predictors of long-term visual field progression in the Leuven Eye Study.

Abstract

Purpose : The importance of non-intraocular pressure (IOP) related risk factors is stressed by the existence of normal tension glaucoma. The Leuven Eye Study (LES) aims to identify both vascular as non-vascular predictors of visual field progression at its follow-up visits.

Methods : Patients with both high and normal tension glaucoma (HTG and NTG) who returned for a follow-up evaluation were included. Backward selection multivariable regression models included various vascular and non-vascular variables and continuous rate of visual field mean deviation (MD) change as outcome.

Results : 251 patients attended the follow-up visit and had sufficient visual fields (121 NTG, 130 HTG) for evaluation. The median follow-up time was 4.5 years. Median IOP during follow-up was 12.0 mmHg. The overall median rate of progression was -0.2 dB/year, with no significant differences between groups. Fast progression (< -1 dB/year) was detected in 16% of the patients, with 6% evidencing catastrophic progression (< -2 dB/year). Backward selection retained the following significant (p<0.05) and relevant (estimate size <-0.01 MD/year) predictors of future progression ranked according to decreasing estimate size: existing central visual field defect (-0.410 MD/year), preceding glaucoma surgery (-0.290 MD/year), higher MD at baseline (-0.026 MD/year), higher age (-0.013 MD/year) and wider arteriolar diameters (-0.011 MD/year).

Conclusions : Preliminary analysis of the LES cohort showed a slow rate of visual field loss over nearly 5 years of follow-up. Nonetheless, a significant proportion of patients showed signs of clinically meaningful progression, despite median follow-up IOP values in the low teens. In such cases, IOP-independent factors, such as vascular dysfunction as potentially depicted by the arteriolar diameters, might have contributed to the detected progression. Further in-depth exploration of these data is needed.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.