Fast Progressors in Primary Open-Angle Glaucoma: A 5-Year Visual Field Index-Based Classification in a Real-World...

The purpose of this study was to investigate the effect of visual field index (VFI) of identifying especially "fast visual field (VF) progressors" in patients with primary open angle glaucoma (POAG) and to analyze the risk factors.

Fast progression was defined as VFI decline worse than -4.6%/year or mean deviation (MD) worse than -1 decibel (dB)/year. Moderately rapid progression (MRP) was defined using cohort-derived cutoffs (VFI worse than -1.016%/year; MD worse than -0.44 dB/year). Proportions of fast progression and MRP were compared between VFI- and MD-based criteria and across baseline disease stages. Longitudinal VFI change was further analyzed as a continuous outcome using linear mixed-effects models (LMM) with random intercepts and slopes for eyes nested within patients.

A total of 162 participants (315 eyes) were included; 94 (58.02%) were male and 68 (41.98%) were female. VFI indicated a fast progression rate of 0.92% and MRP rate of 20.63%, whereas MD yielded 2.75% and 23.49%, respectively. The proportion of eyes classified as VFI-defined MRP increased markedly with advancing disease stage (p < 0.001). MD-confirmed MRP showed a concordant stage-dependent trend but did not reach statistical significance. In multivariable analysis, worse baseline MD, thinner central corneal thickness, lower spherical equivalent, and older age were independently associated with a steeper annual VFI decline.

In this long-term treated POAG cohort, VFI-defined fast progression was rare; however, VFI-based criteria provided statistically significant stage-dependent discrimination of clinically relevant progression. The results support incorporating longitudinal VFI modeling into routine-care datasets to better identify eyes at higher risk of meaningful functional loss over time.