Optic disc progression and rates of visual field change in treated glaucoma.
OBJECTIVE
To investigate the relationship between optic disc progression and rates of visual field (VF) change in patients with treated glaucoma.


METHODS
Glaucoma patients with repeatable VF loss, ≥8 SITA-Standard 24-2 VF tests and good quality optic disc stereophotographs evaluated over a 10-year period were included. Optic disc photographs were reviewed for signs of glaucoma progression (neuroretinal rim change, widening of retinal nerve fibre layer defect, disc haemorrhage and enlargement of beta-zone parapapillary atrophy) by two glaucoma specialists masked to their temporal sequence. Disagreements were adjudicated by a third grader. VF progression was evaluated using automated pointwise linear regression (PLR) and defined as at least two adjacent test points progressing >1.0 dB/year at p < 0.01. VF progression outcomes were compared with photograph review results.


RESULTS
Three-hundred and eighty nine eyes (389 patients; mean age 64.9 ± 13.0 years; mean baseline MD, -7.1 ± 5.1 dB) were included. Most patients had primary open angle glaucoma (54%). Eighty-two eyes (21%) had confirmed optic disc progression and 115 eyes (29%) met the VF PLR criteria. Eyes with documented optic disc progression had more rapid rates of VF change (-0.66 ± 0.7 versus -0.36 ± 0.7 dB/year, p < 0.01) and met the VF PLR endpoint more often (univariate OR = 1.85, p = 0.02; multivariate OR = 1.78, p = 0.03) than eyes without optic disc progression. There was moderate spatial consistency between the location of the optic disc progression and the hemifield with more rapid progression (81%, kappa = 0.40).


CONCLUSIONS
Treated glaucomatous eyes with documented optic disc progression are at increased risk of diminished visual function over time and may require more aggressive therapy to prevent future vision loss. Among the indicators of structural progression, disc haemorrhage was the single most significant predictor for VF deterioration.
Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, NY, USA. demoraesmd@gmail.com
Carlos G
CG
De Moraes
Jeffrey M
JM
Liebmann
Sung C
SC
Park
Christopher C
CC
Teng
Julia
J
Nemiroff
Celso
C
Tello
Robert
R
Ritch
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D019540:Area Under Curve; D018450:Disease Progression; D005901:Glaucoma / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007429:Intraocular Pressure; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D010781:Photography; D012372:ROC Curve; D012165:Retinal Ganglion Cells / Q000473:pathology; D012189:Retrospective Studies; D014786:Vision Disorders / Q000175:diagnosis*; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields
D000959:Antihypertensive Agents