Proportion of Fast Progressors in the Central versus Global Visual Field Across Varying Glaucoma Severity Groups

To compare the prevalence of fast central visual field (VF) progression with global VF progression in individuals with glaucoma receiving routine clinical care across different stages of glaucoma severity at baseline.

Retrospective cohort study.

This study included 1117 eyes of 759 participants with primary open-angle glaucoma (POAG) with at least five 24-2 VF tests over a minimum of 2-year follow-up. Eyes were classified as early (>-6 dB), moderate (-6 dB to -12 dB), and advanced (-12 dB to -20 dB) based on baseline VF mean deviation (MD). The slopes of global MD and central mean total deviation (MTD₁₀) (12 test points within the central 10° region of 24-2 VF test) were calculated. Proportions of fast progressors (≤-1.0 dB/y for MD and ≤-0.5 dB/y for MTD₁₀) in each glaucoma severity group were determined.

Overall, 7.5% of eyes demonstrated fast rates of progression based on MD, while 12.8% of eyes showed fast rates of progression based on MTD₁₀. When eyes were stratified by baseline glaucoma severity, 6.9% (early), 11.1% (moderate), and 5.8% (advanced) of eyes exhibited fast rates of progression based on MD. Although fast MTD₁₀ progressors were most prevalent in the advanced glaucoma group (20.9%), a notable proportion of eyes with early (10.8%) and moderate glaucoma (15.2%) also exhibited fast rates of change centrally. A considerable proportion of eyes showed fast rates of progression based on MTD₁₀ without concurrent fast MD progression consistent across all glaucoma severity groups (5.5% [early glaucoma], 6.6% [moderate glaucoma], and 15.1% [advanced glaucoma]). In contrast, fast progression based on MD was detected in isolation in a much smaller proportions of patients (1.7% in early glaucoma, 2.5% in moderate glaucoma, and none in advanced glaucoma).

Selective analysis of the MTD₁₀ detected a greater proportion of eyes that exhibited fast progression across all disease severity groups compared to measurements from the entire VF, underscoring the importance of close monitoring for progressive central VF changes in all stages of glaucoma.