Rates of Visual Field Change in Patients With Glaucoma and Healthy Individuals

Abstract

IMPORTANCEEstimating the rate of glaucomatous visual field change provides practical assessment of disease progression and has implications for management decisions.OBJECTIVE To assess the rates of visual field change in patients receiving treatment for glaucoma compared with healthy individuals over an extensive follow-up period and to quantify the impact of important covariates for these rates. DESIGN, SETTING, AND PARTICIPANTSThis prospective longitudinal cohort study was conducted in a hospital-based setting from January 1991 to February 2020. The study included 40 patients receiving treatment for open-angle glaucoma and 29 healthy participants. One eye of each participant was randomly selected as the study eye.EXPOSURES Patients with glaucoma and healthy participants received testing with standard automated perimetry every 6 months. Individual rates of mean sensitivity change were computed using ordinary least-squares regression analysis, and linear mixed-effects modeling was used to estimate the mean rates of mean sensitivity change in the 2 groups and the impact of baseline mean sensitivity, baseline age, and follow-up intraocular pressure for rate estimates.MAIN OUTCOMES AND MEASURES Rate of mean sensitivity change in patients with glaucoma and healthy participants. RESULTS A total of 40 patients with glaucoma (median age, 53.07 years [IQR, 48.34-57.97 years]; 21 men [52%]) and 29 healthy participants (median age, 48.80 years [IQR, 40.40-59.07 years], 17 women [59%]) were followed up for a median of 25.65 years (IQR, 22.49-27.02 years) and 19.56 years (IQR, 16.19-26.21 years), respectively. Most participants (65 individuals [94%]) self-identified as White, with the exception of 2 patients with glaucoma (1 self-identified as Black and 1 as South Asian) and 2 healthy participants (both self-identified as South Asian). The mean follow-up intraocular pressure of patients with glaucoma (median, 15.83 mm Hg [IQR,) was similar to that of healthy participants (median, 14.94 mm Hg [IQR, mm Hg]; P = .25). In an ordinary least-squares regression analysis, 31 patients (78%) with glaucoma had rates of mean sensitivity change within the range of healthy participants (ie, between −0.20 dB/y and 0.15 dB/y). Linear mixed-effects modeling revealed that the mean (SE) rate of mean sensitivity change in healthy participants was 0.003 (0.033) dB/y (95% CI, −0.062 to 0.068; P = .93). In comparison, patients with glaucoma had a mean (SE) rate of mean sensitivity change that was −0.032 (0.052) dB/y faster, but this difference was not statistically significant (95% CI, −0.134 to 0.070; P = .53). Among covariates, only baseline mean sensitivity was associated with the rate of mean sensitivity change (mean [SE], 0.021 [0.010] dB/y/dB; 95% CI, 0.002-0.041; P = .03). CONCLUSIONS AND RELEVANCEThe results of this cohort study suggest that over a median follow-up of more than 25 years, the rate of visual field change in patients receiving treatment for glaucoma was comparable to that of healthy individuals. These findings could guide pra...

The rates of visual field progression in glaucoma and its clinical importance

“…Several clinical trials and longitudinal studies have identified age as an independent risk factor for progression in glaucoma. (11,27,52,53) However, when dealing with individual patients, the consensus is not to treat older individuals more aggressively than younger ones but, in fact, to do the opposite. This paradoxical recommendation makes sense when life expectancy is taken into account: for instance, consider two newly diagnosed male patients with moderate visual field defect and IOPs of 24mmHg, one being 50-year-old and the other being 85-year-old.…”

“…This study confirms that in patients with glaucoma who are actively managed with regular visits, progression tend to be slow and not lead to significant visual disability in most cases, even after 25 years of follow-up. (52) Some practical recommendations regarding visual field monitoring in glaucoma:…”

Rates of Visual Field Change in Patients With Glaucoma and Healthy Individuals—Findings From a Median 25-Year Follow-up

“…To the Editor We read with interest the work by Giammaria et al We do have some observations on the study and some questions to help clarify our understanding of the results:…”

“…Such a long observation period is associated with much attrition, which implies a highly selective follow-up. By the end of the study, were the 40 or so cases more motivated and more compliant with treatment than most patients with glaucoma?…”

“…Typically, in a glaucoma clinic over such a long period of time, we see much comorbidity developing, eg, age-related macular degeneration, cataract, diabetic macular edema, retinal vein occlusion, as well as systemic conditions, such as arterial hypertension and hyperlipidemia. Did the 40 cases that completed the study evade these comorbid conditions? If so, it would make them even more atypical of patients with glaucoma, in general.…”