title: Rates of glaucomatous visual field change in a large clinical population.
abstract: OBJECTIVE
  To determine the rate of glaucomatous visual field change in routine clinical care.
  
  
  METHODS
  Mean deviation (MD) rate was computed in one randomly selected eye of all glaucoma patients and suspects with ≥5 examinations in a tertiary eye-care center. Proportions of "fast" (MD rate, <-1 to -2 dB/y) and "catastrophic" (<-2 dB/y) progressors were determined. The MD rates were computed in tertile groups by the number of examinations, baseline age, and MD. The MD rates were compared to the Canadian Glaucoma Study (CGS), a prospective study with IOP interventions mandated by visual field progression, by pairwise matching of patients by baseline MD.
  
  
  RESULTS
  There were 2324 patients with median (interquartile range) baseline age and MD of 65 (56, 74) years and -2.44 (-5.44, -0.86) dB, and follow-up of 7.1 (4.8, 10.2) years with 8 (6, 11) examinations. The median MD rate was -0.05 (0.13, -0.30) dB/y, while the mean follow-up IOP was 17.1 (15.0, 19.7) mm Hg. The MD rate was progressively worse, with a doubling of fast and catastrophic progressors, with each tertile of increasing age. Worse MD rate was associated with lower follow-up IOP. Neither MD rate nor the number of fast and catastrophic progressors was significantly different in clinical care patients matched to CGS patients.
  
  
  CONCLUSIONS
  Most patients under routine glaucoma care demonstrate slow rates of visual field progression. The MD rate in the current study was similar to an interventional prospective study, but considerably less negative compared to published studies with similar design.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Dalhousie University and Capital Health District Authority, Halifax, Nova Scotia, Canada.
authors.forename: Balwantray C
authors.initials: BC
authors.lastname: Chauhan
authors.affiliation: Department of Ophthalmology and Visual Sciences, Dalhousie University and Capital Health District Authority, Halifax, Nova Scotia, Canada.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Malik
authors.affiliation: Department of Ophthalmology and Visual Sciences, Dalhousie University and Capital Health District Authority, Halifax, Nova Scotia, Canada.
authors.forename: Lesya M
authors.initials: LM
authors.lastname: Shuba
authors.affiliation: Department of Ophthalmology and Visual Sciences, Dalhousie University and Capital Health District Authority, Halifax, Nova Scotia, Canada.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Rafuse
authors.affiliation: Department of Ophthalmology and Visual Sciences, Dalhousie University and Capital Health District Authority, Halifax, Nova Scotia, Canada.
authors.forename: Marcelo T
authors.initials: MT
authors.lastname: Nicolela
authors.affiliation: Department of Ophthalmology and Visual Sciences, Dalhousie University and Capital Health District Authority, Halifax, Nova Scotia, Canada.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Artes
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012607:Scotoma / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology*
keywords: clinical study; glaucoma; progression; visual field