Visual field progression in patients with severe glaucoma

To assess the cumulative risk of progression in glaucomatous eyes in the severe stage of disease.

This was a retrospective observational study. Patients that had severe damage in at least one eye, as defined by three criteria including a mean deviation of ≤ - 20 dB, were included. Glaucoma progression was defined as a loss of ≥ 2 dB in mean deviation confirmed in three consecutive visual field tests, or a persistent loss of two or more lines of vision-not attributable to non-glaucomatous causes-in three consecutive follow-up examinations. Kaplan-Meier survival analysis was used to assess the cumulative incidence of progression of the first eye to reach endpoint in cases where both eyes were eligible.

A total of 143 eyes from 119 patients, were studied over a mean period of 4.9 ± 2.9 years. Baseline mean deviation was - 25.3 ± 3.6 dB. Twenty-three eyes of 22 patients reached the progression endpoint: 14 eyes by visual field criteria and 9 by visual acuity criteria. The cumulative 5-year risk of progression estimated by Kaplan-Meier analysis was 14.6% (95% confidence interval: 6.1-22.2%).

In severe glaucoma patients, we found a cumulative incidence of progression of 2.9% per year during the first 5 years of follow-up. Similar incidences have been reported in other studies of glaucoma at different stages of severity.