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Risk Factors for Visual Field Progression in Primary Angle Closure Disease Over 10 Years: The CUPAL Study
Ruyue Shen1,2, Poemen P Chan1,2,3, Anni Ling1,2
1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
Investigative Ophthalmology & Visual Science
|July 22, 2025
Summary
Monitoring intraocular pressure fluctuation and initial visual field index slope are key for managing primary angle-closure disease progression. Early detection of visual field changes in primary angle-closure glaucoma and suspect/primary angle-closure eyes guides tailored treatment strategies.
Area of Science:
- Ophthalmology
- Glaucoma Research
- Visual Field Analysis
Background:
- Primary angle-closure disease (PACD) encompasses a spectrum of conditions including primary angle-closure suspect (PACS), primary angle-closure (PAC), and primary angle-closure glaucoma (PACG).
- Understanding long-term risk factors for visual field (VF) progression in PACD is crucial for effective disease management and preventing irreversible vision loss.
Purpose of the Study:
- To identify long-term risk factors associated with visual field (VF) progression in eyes with primary angle-closure disease (PACD).
- To analyze risk factors specifically within primary angle-closure suspect (PACS), primary angle-closure (PAC), and primary angle-closure glaucoma (PACG) subtypes.
Main Methods:
- A cohort of PACD eyes with at least a 10-year follow-up was analyzed.
- Visual fields were assessed every 6 months using the Humphrey Field Analyzer 24-2 pattern.
- Cox proportional hazards regression models were employed to identify risk factors for VF progression, considering initial intraocular pressure (IOP) fluctuation and initial visual field index (VFI) slope.
Main Results:
- 31.0% of PACD eyes (40/129) showed VF progression.
- In PACG eyes, higher IOP fluctuation (HR=1.591) and steeper initial VFI slope (HR=3.325) were significant risk factors for VF progression.
- In PACS/PAC eyes, a steeper initial VFI slope (HR=4.848) was associated with VF progression.
Conclusions:
- Higher intraocular pressure (IOP) fluctuation and steeper initial visual field index (VFI) slope are significant predictors of VF progression in primary angle-closure glaucoma (PACG).
- Steeper initial VFI slope is a critical risk factor for VF progression in primary angle-closure suspect (PACS) and primary angle-closure (PAC) eyes.
- Findings support individualized management strategies for PACD based on disease severity and refractive status to monitor key progression indicators.
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