Rates of Glaucomatous Visual Field Change in a Large Clinical Population

Chauhan, Balwantray C.; Malik, Rizwan; Shuba, Lesya M.; Rafuse, Paul E; Nicolela, Marcelo T.; Artes, Paul H.

doi:10.1167/iovs.14-14643

Cited by 163 publications

(183 citation statements)

References 42 publications

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“…This is an oversimplification because impactful localised central and binocular VF loss is sometimes not best measured by a single perimetric index like MD. Still, these calculations are clinically useful when managing a patient over time, especially when decisions 4 Our wide-ranging longitudinal data provide new knowledge about how MD rate might be changing over time. Interestingly, the median rate of MD loss was faster in patients diagnosed in the first half of the decade as compared with the second.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies, using data from treated patients in routine care, have yielded estimates for median rate of MD loss that vary considerably from − 0.05 to − 0.62 dB/year. 1,4 Adding to this literature by considering another large cohort of real-world data would be worthwhile. Furthermore, we are unaware of any studies considering how average rates of VF loss may have changed in the same sample of clinics over a significant period of time and this is the main idea explored in this paper.…”

Section: Introductionmentioning

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: Discussionmentioning

confidence: 99%

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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“…1 We also had proportionally more fast progressors than Chauhan et al, who in a study of 2324 eyes reported only 1.5% of eyes as having a progression rate of faster than 2 dB/year, eyes they labelled as catastrophic progressors. 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.…”

Section: Discussionmentioning

confidence: 90%

“…Kirwan et al found only 2% of patients lost 42 dB/year, with other studies showing only 1.5-15% of patients have a rate of progression exceeding 1.5 dB/year. 3,4,[15][16][17] We favoured the taxonomy proposed by Kirwan et al to group rates of VF progression, as it represents a large clinical audit of glaucoma progression conducted in the United Kingdom. 1 Nevertheless, it is important to emphasise that a direct comparison of progression rates is likely-to some degree-to be confounded by variation in the demographics of included subjects.…”

Section: Discussionmentioning

confidence: 99%

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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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Velocity of Visual Field Progression Implicated in Falls

Fenwick

Lamoureux

2016

JAMA Ophthalmol

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Rates of Glaucomatous Visual Field Change in a Large Clinical Population

Abstract: 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.

Cited by 163 publications

References 42 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

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

Velocity of Visual Field Progression Implicated in Falls

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