Central visual field defect patterns and progression in glaucoma: a multicentre 10-year study

To determine whether baseline central visual field defect (CVFD) distribution and archetypal 10-2 patterns are associated with subsequent central visual field (VF) progression in glaucoma.

This retrospective multicentre longitudinal cohort included 127 eyes of 94 adults with glaucoma, baseline CVFDs, baseline 24-2 mean deviation (MD) better than -6 dB and ≥10 years of Humphrey 10-2 Swedish Interactive Thresholding Algorithm (SITA) Standard follow-up at three centres in Japan. Baseline hemifield involvement, archetypal composition and clinical characteristics were evaluated. Time to progression, defined using clustered pointwise linear regression, was assessed with Cox models adjusted for age, mean intraocular pressure during follow-up and baseline 10-2 MD.

During 12.7 (1.8) years of follow-up, 53 eyes (41.7%) progressed. Inferior defects and both-hemifield defects were more common in progressing eyes than in non-progressing eyes (54.7% vs 16.2%, p<0.001; 41.5% vs 4.1%, p<0.001). In multivariable Cox models, inferior defects (HR 3.27, 95% CI 2.67 to 3.99; p<0.001) and both-hemifield defects (HR 3.71, 95% CI 3.02 to 4.57; p<0.001) were associated with progression. Higher weights of an inferonasal-predominant inferior defect pattern and a nasal both-hemifield pattern were also associated with progression.

In glaucoma eyes with baseline CVFDs, inferior or both-hemifield involvement and specific archetypal 10-2 patterns were associated with long-term central VF progression. Baseline 10-2 defect distribution may support risk stratification and selection of eyes requiring closer central field surveillance.