title: Glaucoma with early visual field loss affecting both hemifields and the risk of disease progression.
abstract: OBJECTIVE
  To evaluate whether damage to both hemifields in glaucomatous eyes predicts more rapid disease progression than does single-hemifield involvement.
  
  
  METHODS
  We reviewed the medical records of 43 660 consecutive patients. Eyes with glaucomatous optic neuropathy, 10 or more Swedish Interactive Threshold Algorithm standard 24-2 visual fields in at least 5 years, and mean deviation (MD) smaller than -6.0 dB were included. Pointwise linear regression was used to determine progression. Cox proportional hazards analysis was used to calculate risk of progression based on different baseline covariates.
  
  
  RESULTS
  We enrolled 205 eyes (205 patients; mean [SD] age, 64.2 [11.0] years; follow-up, 6.5 [1.8] years; number of visual fields, 12.3 [2.9]). Patients were divided into 3 groups: initial superior defect (group A; n = 79; MD, -3.4 [1.9] dB), initial inferior defect (group B; n = 61; MD, -3.4 [1.8] dB), and both hemifields affected (group C; n = 65; MD, -4.2 [1.5] dB). Group C progressed faster than did groups A and B (P < .02). Multivariate analysis showed significant effect of higher baseline intraocular pressure, thinner central corneal thickness, and initial damage to both hemifields.
  
  
  CONCLUSIONS
  Initial damage to both hemifields increases the risk of glaucoma progression. More aggressive therapy should be considered for these eyes.
authors.affiliation: Department of Ophthalmology, Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, USA.
authors.forename: Carlos Gustavo V
authors.initials: CG
authors.lastname: De Moraes
authors.forename: Tiago S
authors.initials: TS
authors.lastname: Prata
authors.forename: Celso
authors.initials: C
authors.lastname: Tello
authors.forename: Robert
authors.initials: R
authors.lastname: Ritch
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Liebmann
mesh_terms: D000368:Aged; D000465:Algorithms; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000503:physiopathology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014786:Vision Disorders / Q000503:physiopathology*; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology*