Visual field progression patterns in the ocular hypertension treatment study correspond to vulnerability regions of the disc

Ari Leshno; Nikhil Bommakanti; Carlos Gustavo De Moraes; Mae O Gordon; Michael A Kass; George A Cioffi; Jeffrey M Liebmann

doi:10.1038/s41433-024-02949-x

Visual field progression patterns in the ocular hypertension treatment study correspond to vulnerability regions of the disc

Eye (Lond). 2024 Feb 14. doi: 10.1038/s41433-024-02949-x. Online ahead of print.

Authors

Ari Leshno^{1

2}, Nikhil Bommakanti^{1

3}, Carlos Gustavo De Moraes⁴, Mae O Gordon⁵, Michael A Kass⁵, George A Cioffi¹, Jeffrey M Liebmann¹

Affiliations

¹ Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA.
² Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
³ Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
⁴ Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA. cvd2109@cumc.columbia.edu.
⁵ Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA.

PMID: 38355667
DOI: 10.1038/s41433-024-02949-x

Abstract

Objectives: To determine the locations on the 24-2 visual field (VF) testing grid that are most likely to progress in patients with ocular hypertension (OHTN). Based on a structural model of superior and inferior areas of relative vulnerability at the optic disc, we hypothesized that the nasal and paracentral regions are more prone to show a reduction in sensitivity.

Methods: Posthoc analysis of data collected in phases 1 and 2 of the Ocular Hypertension Treatment Study (OHTS). A pointwise analysis was applied to determine the progression patterns in the early and delayed treatment groups. Each group's progression rate and frequency were calculated for each of the 52 locations corresponding to the 24-2 VF strategy, using trend- and event-based analyses, respectively.

Results: For the event-based analysis, the events were most commonly found in the nasal and paracentral regions. The same regions, with some modest variation, were found to have the fastest rates of progression (ROP) measured with trend analysis. A similar pattern of progression was observed in both the early and delayed treatment groups. The difference in event rates and ROP between the early and delayed treatment groups was also greatest in the nasal and paracentral regions.

Conclusions: Development of VF loss in ocular hypertensive eyes appears to be consistent with the vulnerability zones previously described in glaucomatous eyes with established VF loss. Ocular hypotensive treatment likely helps to slow the rate of progression in these regions. This suggests that careful monitoring of these locations may be useful.