Predictors of Long-Term Visual Field Fluctuation in Glaucoma Patients

Area of Science:

• Ophthalmology
• Optometry
• Glaucoma Research

Background:

• Visual field (VF) fluctuation is a common challenge in glaucoma management.
• Accurate identification of VF progression is crucial for timely treatment adjustments.

Purpose of the Study:

• To identify predictive factors for visual field (VF) fluctuation in glaucoma patients.
• To develop a model that explains the variance in VF fluctuation.

Main Methods:

• Retrospective cohort study of 1392 eyes from 816 patients with at least 6 VFs and 3 years of follow-up.
• Regression analysis was used to model VF trends and estimate variability (RMSE).
• Least absolute shrinkage and selection operator (LASSO) regression identified predictors such as IOP fluctuation, baseline MD, and false positive/negative rates.

Main Results:

• Predictors of global VF fluctuation included left eye, Asian descent, larger IOP fluctuation, cataract surgery, longer follow-up, worse baseline MD, faster VF decay, and higher FP/FN rates.
• Pointwise VF fluctuation was associated with larger IOP fluctuation, longer follow-up, higher VF frequency, glaucoma surgery, worse baseline MD, faster VF decay, and higher FP/FN rates.
• The multivariable model explained 57% of pointwise and 28% of global VF fluctuation variances.

Conclusions:

• Novel predictors of VF fluctuation were identified, explaining a significant portion of pointwise variance.
• Increased testing frequency and improved analytics are recommended for accurate VF progression detection, especially in patients with identified risk factors.