Comparison of Rates of Fast and Catastrophic Visual Field Loss in Three Glaucoma Subtypes

To compare the distribution of visual field progression rates in three subgroups of glaucoma, being primary angle-closure glaucoma (PACG), POAG, and juvenile open-angle glaucoma (JOAG).

We assessed glaucoma patients treated in an Indian tertiary care setting with at least four visual field assessments. We determined rates from a single eye of each of 525 patients using linear regression of the summary index mean deviation (MD) over time. The main outcome measures were the proportions of fast (<-1.0 to -2.0 dB/y) and catastrophic (<-2 dB/y) visual field progression. Bootstrapped 95% CIs allowed comparison with published data from a large clinical cohort in Canada.

The combined proportion of fast and catastrophic progressors in our cohort was less than half that in the Canada dataset (2.3% vs. 5.8%), despite median progression rates differing by only 0.03 dB/y. PACG, POAG, and JOAG represented 45%, 32%, and 12% of our cohort, respectively. Baseline MD values were similarly distributed between these subtypes. All subtypes showed a similar shaped distribution for progression rates, with median progression rates of -0.03, -0.05, and 0.02 dB/y for PACG, POAG, and JOAG, respectively. Combined proportions of fast and catastrophic progression rates did not significantly differ between subtypes.

Differences in fast and catastrophic visual field progression can exist despite only small changes in median progression rates, highlighting the importance of considering the full shape of the progression rate distribution when comparing the risk of devastating visual field loss.