To identify risk factors for central visual field progression in moderate to advanced glaucoma

Abstract

Purpose: To identify the risk factors for central visual field progression in moderate to advanced glaucoma. Methods: We included patients with moderate to advanced primary glaucoma who had undergone at least five reliable Humphrey visual field (HVF) 10-2 tests with follow-up of at least 2 years. Regression slopes for each threshold location on the 10-2 plot were calculated. A test location with a regression slope worsening more than -1 dB/year with P < 0.01 was labeled as a progressing point on point-wise linear regression (PLR) analysis. We compared point-wise progression with progression on the 10-2 mean deviation (defined as a negative MD slope P < 0.05). Results: Ninety-six eyes of 74 patients with a median follow-up of 4 years (±1.97) were included. The median mean deviation 10-2 (MD) at inclusion was -19.01 dB (interquartile range [IQR] -13.2 to -24.14). Eighteen eyes (18.75%) had moderate glaucoma and 78 eyes (81.25%) had advanced glaucoma. The baseline median 24-2 MD in moderate glaucoma was -10.35 dB (IQR -11.35 to -9.25) and in advanced glaucoma was -24.96 dB (IQR -28.48 to -18.26). Based on 10-2 PLR, 27 eyes (28%) showed progression. On multivariate logistics regression analysis, the rate of change for 10-2 MD was a risk factor for progression based on 10-2 PLR analysis: odds ratio (OR) 0.04 (95% confidence interval [CI]: 0.006–0.323), P = 0.002, and for progression based on 10-2 MD analysis: OR 0.03 (95% CI: 0.002–0.602), P = 0.02. In addition, average MD 24-2 (OR 1.343 [95% CI: 1.006–1.793], P = 0.04) and visual field index (OR 0.787 [95% CI: 0.649–0.954], P = 0.01) were found to be risk factors based on 10-2 PLR. Conclusion: Rate of change for 10-2 mean deviation and baseline damage were predictors of point-wise progression.

Keywords

• moderate to advanced glaucoma
• rate of change 10-2 md. 10-2 plr
• risk factors for central visual field progression