Progression of visual field in patients with primary open‐angle glaucoma – ProgF study 1

Abstract

ABSTRACT.Purpose: To evaluate the visual field rate of progression of patients with treated ocular hypertension (OHT) and primary open-angle glaucoma (POAG) in clinical practice, using the mean deviation (MD) and the visual field index (VFI). Methods: Non-interventional cohort study. From a large multicentre database representative of the French population, 441 eyes of 228 patients with treated OHT or POAG followed up at least 6 years with Humphrey 24.2 Sita-Standard visual field examination at least twice a year were identified. From initial data, eyes were classified in five groups: 121 with OHT, 188 with early glaucoma (MD greater than À6 dB), 45 with moderate glaucoma (MD À6 to À12 dB), 41 with advanced glaucoma (MD À12 to À18 dB) and 46 with severe glaucoma (MD less than À18 dB). Rate of progression during the follow-up period was calculated using the trend analysis of the Guided Progression Analysis software. Results: The mean duration of follow-up was 8.4 AE 2.7 years and the mean number of visual field, 18.4 AE 3.5. In eyes with OHT, rate of progression was À0.09 dB/year (À0.17%VFI/year). In eyes with POAG, rate of progression was À0.32 dB/year (À0.83%VFI/year) in eyes with early glaucoma, À0.52 dB/ year (À1.81%VFI/year) in moderate glaucoma, À0.54 dB/year (À2.35%VFI/ year) in advanced glaucoma and À0.45 dB/year (À1.97%VFI/year) in severe glaucoma. In eyes with POAG, a significant progression (p < 0.05) was detected in 159 of 320 eyes (49.7%) with trend analysis and 117 of 320 eyes (36.6%, likely progression) or 183 of 320 eyes (57.2%, possible and likely progression) with event analysis.Conclusions: Primary open-angle glaucoma is a progressive disease in the majority of patients despite cautioned treatment and follow-up. The rate of progression varies greatly among subjects.

Comparison of Glaucoma Progression Detection by Optical Coherence Tomography and Visual Field

“…8,9 In addition, the visual field index (VFI), which was introduced in 2008, 10 has gained popularity in clinics for tracking glaucoma progression. 11–13 Event and trend-based progression analyses showed similar sensitivity and specificity but moderate agreement. 14 However, VF tests are difficult for some patients and are known to have increased variability, especially in patients with advanced disease.…”

What rates of glaucoma progression are clinically significant?

“…However, median rates of loss of glaucoma patients in treated clinical practice vary widely among studies, ranging from -0.05dB/year to -0.62dB/year [16-19]. Others have reported average rates of VFI loss in glaucoma patients to be between -1.1 and -1.5%/year [20-22]. Placing this in perspective, rates of VF sensitivity decline due to aging have been estimated to be -0.06dB/year [23].…”

“…Distributions of rates of loss in various studies suggest that though most do not progress very quickly, a sizeable proportion of eyes do, as reflected by the fact that the mean rates of VF loss in studies are systematically more pessimistic than medians [15-17]. The reported proportion of glaucomatous eyes progressing at faster than -1.5 dB/year have varied from 3 to 17% in some previous studies [16, 17, 19, 20, 30-35], while others found that 15-20% of eyes seem to progress at rates of VFI loss greater than 5% per year [21, 36]. Such rates of loss would lead to perimetric blindness in 20 years assuming rates of loss remain constant.…”

Detecting Change Using Standard Global Perimetric Indices in Glaucoma

“…20 The rate of change of VFI is now incorporated in the HFA’s Guided Progression Analysis software, and so it has become widely used both clinically and in recent research studies. 21–23 …”