Risk Factors for Fast Visual Field Progression in Glaucoma

Ji Hyun Kim; Alessandro Rabiolo; Esteban Morales; Fei Yu; Abdelmonem A Afifi; Kouros Nouri-Mahdavi; Joseph Caprioli

doi:10.1016/j.ajo.2019.06.019

Risk Factors for Fast Visual Field Progression in Glaucoma

Am J Ophthalmol. 2019 Nov:207:268-278. doi: 10.1016/j.ajo.2019.06.019. Epub 2019 Jun 22.

Authors

Ji Hyun Kim¹, Alessandro Rabiolo², Esteban Morales³, Fei Yu⁴, Abdelmonem A Afifi⁵, Kouros Nouri-Mahdavi³, Joseph Caprioli⁶

Affiliations

¹ Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; Siloam Eye Hospital, Seoul, Korea.
² Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy.
³ Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
⁴ Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
⁵ Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
⁶ Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA. Electronic address: caprioli@jsei.ucla.edu.

PMID: 31238025
DOI: 10.1016/j.ajo.2019.06.019

Abstract

Purpose: To identify baseline and longitudinal risk factors for fast visual field (VF) decay in patients with open-angle glaucoma.

Design: Retrospective cohort study.

Methods: Patients with open-angle glaucoma with ≥6 VFs and ≥4 years of follow-up were included. VF decay rates were measured with the following methods: mean deviation (MD) rate, VF index (VFI) rate, and the Glaucoma Rate Index (GRI). The relationship between VF rates and clinical variables were investigated with linear mixed models. Logistic regression analysis was performed to determine which factors were associated with fast progression.

Results: A total of 1317 eyes of 745 patients with a mean (± SD) age of 63.3 (±10.9) years and a median (interquartile range) MD -2.4 (-0.7 to -5.6) dB at baseline were analyzed. The median (interquartile range) number of VFs was 12 (9 to 16), and mean follow-up duration was 11.5 (±3.7) years. Older age (P < .001), higher peak intraocular pressure (IOP) (P < .001), and glaucoma surgery during the study period (P < .001) were associated with faster rates of progression regardless of the method used. Worse baseline MD was associated with MD rate (P = .02), but neither with VFI rate (P = .37) nor GRI (P = .31); whereas pseudoexfoliative glaucoma was associated with faster rates of progression with MD (P = .008) and VFI (P = .01) rates, but not with GRI. Higher peak IOPs (P = .005) was a significant predictor for fast progression.

Conclusion: In this cohort, older age, peak IOP, pseudoexfoliative glaucoma, and baseline MD were associated with the rate of glaucomatous VF worsening. Fast progressors had a higher peak IOP than non-fast progressors. The identification and appropriately aggressive treatment of fast progressors would reduce visual disability from glaucoma.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Disease Progression
Female
Follow-Up Studies
Glaucoma, Open-Angle / diagnosis*
Glaucoma, Open-Angle / physiopathology
Humans
Intraocular Pressure / physiology
Male
Middle Aged
Retrospective Studies
Risk Factors
Vision Disorders / diagnosis*
Vision Disorders / physiopathology
Visual Field Tests
Visual Fields / physiology*