Focusing on glaucoma progression and the clinical importance of progression rate measurement: a review

Abstract

Purpose This review aims to provide guidance in managing glaucoma patients more effectively. It focuses on the importance of detecting progression and measuring its rate within the management of primary open-angle glaucoma today. Recent findings strongly indicate that continued monitoring of visual fields (VFs) and reassessment of target intraocular pressures (IOPs) depending on VF progression rates are mandatory in the management of glaucoma. Methods Data on glaucoma progression from older as well as most recent literature findings are summarized in this article. In addition, the article elaborates on the scientific content from a series of lectures given by experts in the field during several international symposia on 'rate of progression ' in 2008. Results This review summarizes key findings on the natural history of glaucoma and known factors for disease progression. It highlights the visual function changes observed as glaucoma progresses and discusses disease impact on patients' quality of life. Findings support the need to obtain information on rate of progression and its importance for clinical management. Practical ways to measure rate of progression are given by new software options to help measure major parameters. Finally, on the basis of a patient's individual rate of progression therapeutic options are assessed, such as maximum medical therapy with fixed combinations. Conclusions Estimating a patient's individual rate of VF progression by using newly developed analyses will be helpful to forecast the potential future development of the glaucoma. An individualized treatment approach then requires that in patients in whom the risk of becoming visually impaired or blind during their lifetime is higher, a more intensive medical IOP-lowering therapy such as fixed combinations can be considered as treatment option.

Citicoline Oral Solution in Glaucoma: Is There a Role in Slowing Disease Progression?

“…-1.1 dB/year) when compared with commonly reported rates of progression in treated patients. In fact, rates of progression usually range between 0.3 and 0.6 dB/year as reported in the published literature [6,7,9,33]. All of these patients had POAG, and other ‘more aggressive' forms (e.g.…”

A rat experimental model of glaucoma incorporating rapid-onset elevation of intraocular pressure

“…Untreated glaucoma requires approximately 14.4, 6.5 and 2.9 years to progress from early-stage to end-stage if the IOP is in the range of 21 to 25 mmHg, 25 to 30 mmHg and more than 30 mmHg, respectively282930313233. The short lifespan of the small rodents being utilized in experimental glaucoma models provides a relatively short time to follow up on pressure-induced changes.…”

Spatial Modeling of Visual Field Data for Assessing Glaucoma Progression

“…Vesti et al 9(p3878) states that ''The ideal method for analyzing VF change should be sensitive, detect progression with few examinations, maintain high specificity, and be resistant to fluctuation,'' and it has been noted that a method which identifies the rate of progression is of more benefit in determining the future of vision loss, treatment, and thus quality of life in glaucoma patients. 10 We suggest that statistical techniques be employed to model the spatial correlation of the VF data, which in turn will help minimize variation in the VF data. Previously, a spatial filter was introduced to take a weighted average of the surrounding points.…”