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Abstract
PurposeTo investigate risk factors associated with progressive visual field (VF) loss in primary angle closure glaucoma (PACG).MethodsWe retrospectively reviewed medical record of PACG patients who had ≥5 reliable VF examinations (central 24-2 threshold test, Humphrey Field Analyzer) and ≥2 years of follow-up. Each VF was scored using Collaborative Initial Glaucoma Treatment Study system. Progression was defined if 3 consecutive follow-up VF tests had an increased score of ≥3 above the mean of the first 2 VF scores. Factors associated with VF progression were evaluated by Cox proportional hazards models.ResultsA total of 89 eyes from 89 patients (mean age, 69.8 ± 7.9 years), who received a mean of 6.9 ± 2.3 VF tests (mean deviation at initial, -8.1 ± 4.4 dB) with a mean follow-up of 63.9 ± 23.9 months were included. VF progression was detected in 9 eyes (10%). The axial length (AL), anterior chamber depth, and intraocular pressure (IOP) in patients with and without progression were 22.5 ± 0.6 and 23.1 ± 0.9 mm, 2.5 ± 0.3 and 2.5 ± 0.3 mm, 14.8 ± 2.4 and 14.3 ± 2.3 mm Hg, respectively. AL was the only factor associated with progression in both Cox proportional hazards univariate (p = 0.031) and multivariate models (p = 0.023).ConclusionWhen taking into account age, IOP, follow-up period, and number of VF tests, a shorter AL is the only factor associated with VF progression in this cohort of Chinese patients with PACG. Further studies are warranted to verify the role of AL in progressive VF loss in PACG.
Highlights
Glaucoma is the second leading cause of blindness worldwide [1,2]
This study showed that a shorter axial length (AL) was a risk factor for progressive visual field (VF) defects in Chinese patients under treatment for primary angle closure glaucoma (ACG) (PACG)
Quek et al have reported that higher mean intraocular pressure (IOP) and the presence of previous acute angle closure (AAC) were associated with progression of VF defects in a study of Chinese patients with PACG [15]
Summary
The proportion of blindness caused by angle closure glaucoma (ACG) is greater than that caused by open angle glaucoma (OAG) [1,3]. Few studies have assessed risk factors associated with disease progression in primary ACG (PACG). Since MD is subject to many factors such as test variability and lens opacity, comparing MD between two time points may not reflect true glaucoma progression. Another retrospective study conducted by the same group found that long-term IOP fluctuation was associated with progressive VF deterioration in PACG [14]. Risk factors for VF progression in PACG remain elusive
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