Visual Field Progression in Childhood Glaucoma Versus Open-Angle Glaucoma: A Retrospective Comparative Study

Area of Science:

• Ophthalmology
• Glaucoma Research
• Visual Field Analysis

Background:

• Limited evidence exists on long-term visual field progression in childhood glaucoma versus adult open-angle glaucoma (OAG).
• Understanding progression rates and predictors is crucial for effective management of pediatric and adult glaucoma.

Purpose of the Study:

• To compare the rate and timing of visual field progression between childhood glaucoma and OAG.
• To identify predictors of final visual field status in these patient groups.

Main Methods:

• Retrospective observational study of 171 eyes (87 childhood glaucoma, 84 OAG) with ≥3 visual field tests and ≥2 years follow-up.
• Visual fields assessed using Octopus perimeter (G grid, TOP strategy); progression evaluated by mean defect (MD) rate (dB/year).
• Statistical analyses included Mann-Whitney U test, Kaplan-Meier, restricted mean survival time (RMST), Cox models, and multiple linear regression.

Main Results:

• Childhood glaucoma had worse baseline MD and higher surgery rates; OAG used more medications.
• Median MD progression rate was -2.3 dB/year in childhood glaucoma vs. 0.0 dB/year in OAG (p < 0.001), indicating slower deterioration in pediatric cases.
• Progression-free survival and timing to first progression were similar between groups; baseline MD was the strongest predictor of final MD.

Conclusions:

• Visual field deterioration appears slower in childhood glaucoma compared to OAG, despite worse baseline status.
• Current management strategies may contribute to functional stability in childhood glaucoma.
• Individualized follow-up and timely intervention are recommended, particularly for pediatric glaucoma patients.