Examining Visual Field Loss in Patients in Glaucoma Clinics During Their Predicted Remaining Lifetime

Saunders, Luke J.; Russell, Richard A.; Kirwan, James; McNaught, Andrew; Crabb, David P.

doi:10.1167/iovs.13-13006

Cited by 94 publications

(125 citation statements)

References 44 publications

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“…As described elsewhere, 9,10,12 Eyes with short follow-up (less than 4 years or less than five examinations) were excluded. The first VF examination in each series were then removed from further analysis to account for perimetric learning effects.…”

Section: Methodsmentioning

confidence: 99%

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Are rates of vision loss in patients in English glaucoma clinics slowing down over time? Trends from a decade of data

Boodhna

Saunders

Crabb

2015

Eye

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Purpose To examine changes in rates of visual field (VF) progression in patients attending a sample of glaucoma clinics in England between 1999 and 2012. Methods An archive of 473 252 Humphrey VFs recorded across the UK was retrospectively examined. Distribution of rates recorded in the first half of the decade was compared with the second. The relationship between age and severity of MD loss at baseline with rates of loss and frequency of testing was examined. Results VF series from 18 926 eyes were analysed. Median rate of MD loss for the period before and after 2003 was − 0.11 and − 0.06 dB/year, respectively, but the proportion of eyes with medium or fast rates of MD loss remained constant. Median rate of MD loss in older (470 years) eyes was faster than that observed in younger (o60 years) eyes (−0.21 compared with − 0.01 dB/ year). Median rate of loss did not vary with severity of MD loss at baseline. Frequency of testing, typically carried out annually, did not vary by age, rate of loss or disease severity. Conclusions VFs of eyes treated in the first half of the decade deteriorated more rapidly than those in the second half. Several factors might explain these differences but average effects were small and there was no reduction in the proportion of rapidly progressing eyes over the decade. Older age and, to a lesser extent, worse VF damage at diagnosis are indicators for faster VF loss in clinics, but frequency of VF testing was similar for all patients.

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Section: Methodsmentioning

confidence: 99%

“…[5][6][7][8] Automated perimetry has been routinely used in glaucoma clinics for more than 20 years and VF data recorded electronically in many centres can be used to monitor trends in health service delivery of glaucoma. 9,10 This approach, using large-scale VF data, is adopted in the methodology of this study.…”

Section: Introductionmentioning

confidence: 99%

Are rates of vision loss in patients in English glaucoma clinics slowing down over time? Trends from a decade of data

Boodhna

Saunders

Crabb

2015

Eye

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“…Estimates for this vary 1 but it might be reasonable to suggest about 1 in 20 treated patients have a real lifetime risk of serious visual impairment and there is evidence to support this from data collected in UK clinics. 2,3 Nevertheless, loss of visual field before it reaches the stage of causing advanced loss of sight affects patients' everyday life and this is central to the discussion in this article. This should not be underestimated.…”

Section: Introductionmentioning

confidence: 99%

A view on glaucoma—are we seeing it clearly?

Crabb

2015

Eye

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Successful clinical management of glaucoma should not simply be about control of intraocular pressure, but must equate to correct decisions about intensifying treatment when patients are at risk of developing 'visual disability'. Yet little is known about what visual field defects, at different stages of glaucoma, specifically affect patients' abilities to perform everyday visual tasks. One way to do this is to measure patient performance in tasks in a lab setting. Another way is to ask patients themselves. The latter can be revealing and demystify views about how patients perceive the world. This short commentary highlights some of the current research in this area.

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“…4 Similarly, Saunders et al found only 3% of glaucomatous eyes lost 41.5 dB/year. 2 Our results indicate that a large proportion of patients (almost one quarter) attending for trabeculectomy had no significant progression in MD documented. Further review of the case notes for the apparently slow or nonprogressing patients revealed the main indications for trabeculectomy to be suboptimal control of IOP despite medical treatment or intolerance to topical medications.…”

Section: Discussionmentioning

confidence: 59%

“…However, it is only recently that investigators have explored rates of change in VF in large 'real-life' clinical cohorts. [1][2][3][4] These studies have reported average rates of VF loss in glaucoma and identified fast, moderate, slow, and nonprogressors.…”

Section: Introductionmentioning

confidence: 99%

Prior rates of visual field loss and lifetime risk of blindness in glaucomatous patients undergoing trabeculectomy

Foulsham

Tatham

2015

Eye

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Purpose Trend-based analyses examining rates of visual field (VF) loss in glaucoma are useful for predicting risk of vision-related morbidity. Although patients with faster losses are likely to require treatment escalation, little is known about rates that might trigger a decision to intervene surgically. The aims of this study were to investigate prior rates of VF loss in patients attending for trabeculectomy and to estimate, in the absence of surgical intervention, lifetime risk of visual impairment, and blindness. Patients and methods A retrospective analysis of 117 eyes of 86 consecutive patients with glaucoma attending for trabeculectomy, including 53 patients referred from general ophthalmology clinics and 33 patients from specialist glaucoma clinics. Rates of change in standard automated perimetry mean deviation were examined using linear regression and random coefficient models. Risk of lifetime visual impairment and blindness was calculated using life expectancy data. Results Mean age at surgery was 71.0 ± 9.7 years. Patients were followed for 10.7 ± 7.5 years prior to surgery with an average of seven useable fields per eye. On average patients referred from general clinics lost 1.04 dB/year compared with 0.77 dB/year in those referred from glaucoma clinics (P = 0.070). Patients referred from general clinics had more medication changes prior to surgery (3.4 and 2.6 changes, respectively; P = 0.004). Given Scottish life expectancy data, untreated, 61 eyes (52%) would have passed the threshold for visual impairment, whereas 40 (34%) would have passed the threshold demarcating blindness.Conclusion Patients attending for trabeculectomy had faster average rates of field loss prior to surgery than published values for the general glaucoma population with over one-third of eyes studied predicted to have become blind without intervention. Those managed by glaucoma specialists had fewer changes in medication and tended to slower rates of VF loss, although the latter did not reach statistical significance.

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Examining Visual Field Loss in Patients in Glaucoma Clinics During Their Predicted Remaining Lifetime

Cited by 94 publications

References 44 publications

Are rates of vision loss in patients in English glaucoma clinics slowing down over time? Trends from a decade of data

Are rates of vision loss in patients in English glaucoma clinics slowing down over time? Trends from a decade of data

A view on glaucoma—are we seeing it clearly?

Prior rates of visual field loss and lifetime risk of blindness in glaucomatous patients undergoing trabeculectomy

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