Predictive factors for glaucomatous visual field progression in the Advanced Glaucoma Intervention Study

Area of Science:

• Ophthalmology
• Clinical Research
• Glaucoma Studies

Background:

• Glaucoma is a leading cause of irreversible blindness.
• Visual field (VF) progression is a key indicator of glaucoma severity and treatment efficacy.
• Identifying risk factors for VF progression is crucial for timely intervention.

Purpose of the Study:

• To identify risk factors associated with visual field (VF) progression in patients with advanced glaucoma.
• To analyze serial VF data using pointwise linear regression (PLR) within the Advanced Glaucoma Intervention Study (AGIS) cohort.

Main Methods:

• A cohort study utilizing data from a prospective, multicenter, randomized clinical trial (AGIS).
• Included 509 eyes from 401 patients with baseline VF score ≤16, ≥7 VF examinations, and ≥3 years follow-up.
• Defined VF progression as worsening of ≥2 test locations within a Glaucoma Hemifield Test cluster using PLR analysis (≥1.00 dB/year change, P≤0.01).
• Multivariate logistic regression analyzed risk factors, including intraocular pressure (IOP) fluctuation (standard deviation of IOP).

Main Results:

• Visual field progression was detected in 30% of eyes (151/509) over a mean follow-up of 7.4 years.
• Older age at intervention, greater IOP fluctuation, increased number of glaucoma interventions, and longer follow-up were associated with increased odds of VF progression.
• IOP fluctuation was the only consistently significant risk factor for VF progression, regardless of cataract extraction history.

Conclusions:

• Increasing age and greater IOP fluctuation are significant risk factors for VF progression in advanced glaucoma.
• Each 5-year increase in age and each 1-mmHg increase in IOP fluctuation raise VF progression odds by 30%.
• IOP fluctuation's impact on VF progression is consistent across patients with and without prior cataract surgery.