Abstract
Purpose :
To identify associated risk factors of long-term visual field (VF) progression among eyes of primary angle closure disease (PACD), including primary angle closure suspect (PACS), primary angle closure (PAC), and primary angle closure glaucoma (PACG).
Methods :
This is a prospective cohort study. Eyes with at least a ten-year follow-up duration were recruited from an ongoing prospective, observational PACD cohort study. Comprehensive eye examinations were performed at baseline and each follow-up visit, including axial length (AL), intraocular pressure (IOP), and retinal nerve fiber layer thickness (RNFL) measurement. VF was tested every 6 months using 24-2 pattern SITA on the Humphrey Field Analyzer (HFA) (Carl Zeiss Meditec Inc., Dublin, CA, USA). The initial IOP fluctuation and VF slope were calculated based on the first-year follow-up data. VF progression was determined by the Guided Progression Analysis (GPA) of the HFA. Univariable and multivariable Cox proportional hazards regression models were calculated to assess associations of potential predictive factors with VF progression.
Results :
A total of 129 PACD eyes were included in the analysis, including 11 (8.5%) PACS eyes, 52 (40.3%) PAC eyes, and 66 (51.2%) PACG eyes. 40 of 129 (31.0%) eyes with PACD developed VF progression, including 2 (5.0%) PACS eyes, 9 (22.5%) PAC eyes, and 29 (72.5%) PACG eyes. In the multivariable Cox models, baseline longer AL, baseline more severe disease severity, higher initial IOP fluctuation, and steeper initial visual field index (VFI) slope at the first-year follow-up were associated with VF progression in PACD eyes (all p ≤ 0.031). Subgroup analysis showed that the hazard ratio [HR] for initial IOP fluctuation was 1.591 (95% confidence interval [CI], 1.128 - 2.245), and for initial VFI slope was 3.325 (95% CI, 2.046 - 5.404) in PACG eyes. Among PACS/PAC eyes, the steeper VFI slope was associated with VF progression in both univariable and multivariable models (p ≤ 0.008).
Conclusions :
Baseline longer AL, more severe disease severity, initial larger IOP fluctuation, and initial steeper VFI slope were associated with a higher risk of long-term VF progression among eyes of PACD.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.