Central Visual Field Progression Research Articles

Clinical Significance of Recurrent Disc Hemorrhage and Choroidal Microvasculature Dropout on Optical Coherence Tomography Angiography in Glaucoma.

The purpose of this study was to investigate the clinical significance of recurrent disc hemorrhage (DH) and choroidal microvasculature dropout (MvD). A retrospective cohort study was conducted of 181 eyes with open-angle glaucoma. The clinical characteristics of patients with nonrecurrent and recurrent DH with and without MvD were investigated. Fifty-eight patients (32.0%) had a single, nonrecurrent DH, and 63 (34.8%) had more than one DH. Sixty eyes (33.1%) with no history of DH were presented as a control group. MvD was more frequent in the recurrent DH group (44.4%) than in the nonrecurrent DH group (27.6%, P = 0.041). The recurrent DH with MvD group experienced more frequent central visual field (VF) progression (71.4%) than the recurrent DH without MvD group (17.1 %, P < 0.001). The recurrent DH without MvD group had a higher frequency of DH recurrence at different locations (42.9%) and more vascular symptoms (37.1%) than the recurrent DH with MvD group (14.3% and 7.1%, P = 0.013 and P = 0.005, respectively). Presence of DH, presence of MvD, vascular symptoms, and DH recurrence at different locations were the factors associated with central VF progression in multivariate analysis. DH occurrence and the presence of MvDs constitute critical parameters associated with central VF progression. In the presence of MvD, recurrent DH was more likely to recur at the same location as the MvD, whereas recurrent DH without MvD was related to vascular symptoms and recurred at other locations. When eyes present with recurrent DH and MvD, closer follow-up and more aggressive treatment are required to prevent the progression of central VF.

Factors Contributing to the Development of Choroidal Microvasculature Dropout in Glaucoma Suspects and Patients with Glaucoma.

We aimed to characterize and compare the occurrence of peripapillary microvasculature dropout (MvD) between glaucoma suspects and patients with glaucoma. In addition, the factors related to the development of parapapillary MvD in glaucoma suspects and patients with glaucoma were investigated. Of a total 150 eyes, 68 eyes of glaucoma suspects and 82 eyes of glaucoma patients were analyzed in this study. Univariate and multivariate logistic regression analyses were used to identify factors associated with MvD development. The classification of glaucoma patients or glaucoma suspects was not significantly associated with MvD development (beta 1.368, 95% CI, 0.718-2.608, p = 0.341). In the regression analysis of the glaucoma suspect group, greater axial length (beta 1.520, 95% CI, 1.008-2.291, p = 0.046) and baseline cup volume (beta 3.993, 95% CI, 1.292-12.345, p = 0.035) among the baseline factors and the slope of ganglion cell-inner plexiform layer (GCIPL) thickness (beta 0.027, 95% CI, 0.072-0.851, p = 0.027) and central visual field (VF) progression (beta 7.040, 95% CI, 1.781-16.306, p = 0.014) among follow-up factors were significantly associated with MvD development. In the glaucoma group, central VF progression (beta 5.985, 95% CI, 1.474-24.083, p = 0.012) and ONH depression (beta 3.765, 95% CI, 1.301-10.895, p = 0.014) among follow-up elements were observed as significant factors and the baseline factor had little relationship. MvD appears not only as a result of the progression of axonal loss of RGC in glaucoma but may also be developed due to structural changes and mechanical susceptibility of the ONH associated with baseline characteristics. Analyzing the structural susceptibility of the ONH can predict the occurrence of MvD, which can be helpful in predicting the progression of glaucoma.

Fluctuation of Intraocular Pressure and Vascular Factors Are Associated With the Development of Epiretinal Membrane in Glaucoma

To identify factors associated with the development of epiretinal membranes (ERM) in glaucoma patients. Multicenter, propensity-score matched, case-control study. One hundred ninety-two eyes of 192 patients with glaucoma from the Catholic Medical Center Glaucoma Suspect Cohort Study were analyzed. We identified 64 eyes who developed ERM from the cohort, and 128 eyes without ERM were selected by propensity score matching (1:2) according to baseline age and mean deviation (MD) of the visual field (VF). Demographic, systemic, and ocular characteristics were determined at baseline. Intraocular pressure (IOP) was measured, including baseline, mean IOP, and IOP fluctuation. Early-stage ERM, defined as translucent membrane with no underlying retinal distortion, was detected by fundus photography and optical coherence tomography. Central VF progression was considered when new VF defets developed in one either or both hemifields or when there was an increase of 3 or more abnormal points within 12 points of central 10° fixation. Autonomic nervous system status was evaluated by heart rate variability. Patients who developed ERM were more frequently receiving medication for systemic hypertension and had higher systolic blood pressure, greater IOP fluctuation, more frequent disc hemorrhage (DH), worse VF MD, and a higher rate of central VF progression than patients without ERM. Additionally, patients with early glaucoma who developed ERM had higher rate of autonomic imbalance while patients with moderate-to-advanced glaucoma who developed ERM had greater baseline and peak IOP and worse MD of the last follow-up VF (MD < 6.0 dB). Older age (P=.048), medication for systemic hypertension (P < .001), IOP fluctuation (P < .001), presence of DH (P < .001), and worse last MD of VF (P=.033) were significantly associated with ERM in Cox proportional hazard analysis. Early stage of ERMs in glaucomatous eyes are significantly associated with glaucoma progression, medication of systemic hypertension, presence of DH, and IOP fluctuation. These suggest that glaucoma patients who develop early stage of ERMs should be carefully monitored in terms of IOP fluctuation, vascular factors, and glaucoma progression.

Progressive Macular Vessel Density Loss and Visual Field Progression in Open-angle Glaucoma Eyes with Central Visual Field Damage

To investigate the association between the longitudinal changes in both macular vessel density (mVD) and macular ganglion cell-inner plexiform layer thickness (mGCIPLT) and visual field (VF) progression (including central VF progression) in open-angle glaucoma (OAG) patients with central visual field (CVF) damage at different glaucoma stages. Retrospective longitudinal study. This study enrolled 223 OAG eyes with CVF loss at baseline classified as early-to-moderate (133 eyes) or advanced (90 eyes) stage based on the VF mean deviation (MD) (-10 dB). Serial mVDs at parafoveal and perifoveal sectors and mGCIPLT measurements were obtained using OCT angiography and OCT during a mean follow-up of 3.5 years. Visual field progression was determined using both the event- and trend-based analyses during follow-up. Linear mixed-effects models were used to compare the rates of change in each parameter between VF progressors and nonprogressors. Logistic regression analyses were performed to determine the risk factors for VF progression. In early-to-moderate stage, progressors showed significantly faster rates of change in the mGCIPLT (-1.02 vs.-0.47 μm/year), parafoveal (-1.12 vs.-0.40%/year), and perifoveal mVDs (-0.83 vs.-0.44%/year) than nonprogressors (all P<0.05). In advanced stage cases, only the rates of change in mVDs (parafoveal:-1.47 vs.-0.44%/year; perifoveal:-1.04 vs.-0.27%/year; all P<0.05) showed significant differences between the groups. By multivariable logistic regression analyses, the faster rate of mVD loss was a predictor of VF progression regardless of glaucoma stage, while the rate of mGCIPLT loss was significantly associated with VF progression only in early-to-moderate stage cases. Progressive mVD loss is significantly associated with VF progression (including central VF progression) in the OAG eyes with CVF loss regardless of the glaucoma stage. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Association of macular vessel density and ganglion cell complex thickness with central visual field progression in glaucoma

Background/aimsTo evaluate the association of macular vessel density (VD) and ganglion cell complex (GCC) thickness with 10–2 central visual field (CVF) progression in glaucoma.MethodsIn this retrospective cohort study, patients with...

A Prospective Longitudinal Study to Investigate Corneal Hysteresis as a Risk Factor of Central Visual Field Progression in Glaucoma

To evaluate the role of corneal hysteresis (CH) as a risk factor of central visual field (VF) progression in a cohort of glaucoma suspect and glaucoma patients. Prospective cohort study. Two hundred forty-eight eyes of 143 subjects who were followed for an average of 4.8 years with a minimum of 5 visits with 10-2 and 24-2 VF tests were included. Univariable and multivariable linear mixed-effects models were used to identify characteristics associated with the rate of change over time in 10-2 and 24-2 mean deviation (MD). Mixed-effects logistic regression was used to evaluate characteristics associated with an increased likelihood of event-based 10-2 VF progression based on the clustered pointwise linear regression criterion. CH was significantly associated with 10-2 and 24-2 VF progression in the univariable trend-based analysis. In multivariable trend-based analyses, lower CH was associated with a faster rate of decline in 10-2 MD (0.07 dB/y per 1 mm Hg, P < .001) but not with 24-2 MD (P=.490). In multivariable event-based analysis, lower CH was associated with an increased likelihood of 10-2 VF progression (odds ratio=1.35 per 1 mm Hg lower, P=.025). Similar results were found in eyes with early glaucomatous damage at the baseline (baseline: 24-2 MD ≥ -6 dB). Lower CH was associated with a statistically significant, but relatively small, increased risk of central VF progression on the 10-2 test grid. Given the substantial influence of central VF impairment on the quality of life, clinicians should consider using CH to assess the risk of progression in patients with primary open-angle glaucoma including those with early disease.

Detecting Progression of Retinitis Pigmentosa Using the Binomial Pointwise Linear Regression Method.

PurposeA method of evaluating central visual field (VF) progression in eyes with retinitis pigmentosa (RP) has still to be established. We previously reported the potential merit of applying a binomial test to pointwise linear regression (binomial PLR) in glaucoma progression. In the current study, we investigated the usefulness of binomial PLR in eyes with RP.MethodsA series of 10 VFs (VF 1–10, Humphrey field analyzer, 10-2 test) from 196 eyes of 103 patients with RP were collected retrospectively. The PLR was performed by regressing the total deviation of all test points with the complete series of 10 VFs. The accuracy (positive predictive value, negative predictive value, and false-positive rate) and the time required to detect VF progression with shorter VF series (from VF 1–5 to VF 1–9) were compared across the binomial PLR, a permutation analysis of PLR (PoPLR), and a mean deviation (MD) trend analysis.ResultsIn evaluating VF progression, the binomial PLR was comparable with the PoPLR and MD trend analyses in its positive predictive value (0.55 to 0.95), negative predictive value (0.67 to 0.92), and false-positive rate (0.01 to 0.05). The binomial PLR required significantly less time to detect VF progression (5.0 ± 2.0 years) than the PoPLR and MD trend analyses (P < 0.01, P < 0.001, respectively).ConclusionsThe application of a binomial PLR achieved reliable and earlier detection of central VF progression in eyes with RP.Translational RelevanceA binomial PLR was useful in assessing VF progression in RP.

Characteristics of Central Visual Field Progression in Eyes with Optic Disc Hemorrhage

To investigate the characteristics and rate of central visual field loss after optic disc hemorrhage (DH). Prospective cohort study. Three hundred forty-three eyes of 220 subjects who had ≥3 years of follow-up with a minimum of 5 visits with 10-2 and 24-2 visual field (VF) were recruited. Rates of 10-2 mean deviation (MD) loss in each hemifield and predefined zones were compared using linear mixed-effects models in DH and non-DH eyes. Clustered pointwise regression analysis was also used to define central VF progressors and compared with 24-2 VF loss using guided progression analysis. Thirty-nine eyes with DH and 304 eyes without DH had a mean follow-up of 5.2 years. Eyes with DH had rates of 10-2 MD loss that were 3 times faster than non-DH eyes (mean difference -0.36 dB/year [95% confidence interval 0.54-0.18]; P < .001) and were 3.7 times more likely to progress (P=.002). A larger proportion of glaucomatous eyes showed central VF progression rather than peripheral VF progression in the DH group (30.8% vs. 20.5%) compared with the non-DH group (10.9% vs. 9.2%). In early glaucoma, the rate of 10-2 MD loss was 5.5 times faster in DH eyes than in non-DH eyes (P < .001). Superonasal and superotemporal central VF regions progressed more rapidly than other regions, especially in DH eyes. Central VF loss is accelerated in glaucoma eyes with DH and it corresponds topographically to the DH location. In patients with glaucoma with DH, one should consider supplementing 10-2 VFs with 24-2 VFS to monitor the disease.

Variability and Power to Detect Progression of Different Visual Field Patterns

To compare the variability and ability to detect visual field (VF) progression of 24-2, central 12 locations of the 24-2 and 10-2 VF tests in eyes with abnormal VFs. Retrospective, multisite cohort. A total of 52 806 24-2 and 11 966 10-2 VF tests from 7307 eyes from the Glaucoma Research Network database were analyzed. Only eyes with ≥ 5 visits and ≥ 2 years of follow-up were included. Linear regression models were used to calculate the rates of mean deviation (MD) change (slopes), whereas their residuals were used to assess variability across the entire MD range. Computer simulations (n= 10 000) based on real MD residuals of our sample were performed to estimate power to detect significant progression (P < 5%) at various rates of MD change. Time required to detect progression. For all 3 patterns, the MD variability was highest within the-5 to-20 decibel (dB) range and consistently lower with the 10-2 compared with 24-2 or central 24-2. Overall, time to detect confirmed significant progression at 80% power was the lowest with 10-2 VF, with a decrease of 14.6% to 18.5% when compared with 24-2 and a decrease of 22.9% to 26.5% when compared with central 24-2. Time to detect central VF progression was reduced with 10-2 MD compared with 24-2 and C24-2 MD in glaucoma eyes in this large dataset, in part because 10-2 tests had lower variability. These findings contribute to current evidence of the potential value of 10-2 testing in the clinical management of patients with glaucoma and in clinical trial design.

Germany & US: Pyrolyx – carbon black from scrap tyres

To compare the variability and ability to detect visual field (VF) progression of 24-2, central 12 locations of the 24-2 and 10-2 VF tests in eyes with abnormal VFs.Retrospective, multisite cohort.A total of 52 806 24-2 and 11 966 10-2 VF tests from 7307 eyes from the Glaucoma Research Network database were analyzed. Only eyes with ≥ 5 visits and ≥ 2 years of follow-up were included.Linear regression models were used to calculate the rates of mean deviation (MD) change (slopes), whereas their residuals were used to assess variability across the entire MD range. Computer simulations (n = 10 000) based on real MD residuals of our sample were performed to estimate power to detect significant progression (P < 5%) at various rates of MD change.Time required to detect progression.For all 3 patterns, the MD variability was highest within the −5 to −20 decibel (dB) range and consistently lower with the 10-2 compared with 24-2 or central 24-2. Overall, time to detect confirmed significant progression at 80% power was the lowest with 10-2 VF, with a decrease of 14.6% to 18.5% when compared with 24-2 and a decrease of 22.9% to 26.5% when compared with central 24-2.Time to detect central VF progression was reduced with 10-2 MD compared with 24-2 and C24-2 MD in glaucoma eyes in this large dataset, in part because 10-2 tests had lower variability. These findings contribute to current evidence of the potential value of 10-2 testing in the clinical management of patients with glaucoma and in clinical trial design.

Nasalization of Central Retinal Vessel Trunk Predicts Rapid Progression of Central Visual Field in Open-Angle Glaucoma

Central visual field (CVF) loss is important in maintaining vision-related quality of life in eyes with open-angle glaucoma (OAG). The present study investigated whether nasalized location of central retinal vessel trunk (CRVT) at baseline is associated with rapid rate of CVF loss in early-stage OAG eyes. This study included 76 OAG eyes with high nasalization CRVT [HNL] group and 75 OAG eyes with low nasalization CRVT [LNL] group matched for glaucoma severity at baseline that showed progressive visual field (VF) loss. The rates of mean threshold changes at various regions were compared in the two groups using a linear mixed model. Clinical variables associated with rapid rate of CVF progression were also identified using a linear mixed model. The rate of CVF loss in the central 10° was significantly higher in the HNL group than that in the LNL group (−0.452 dB/year vs. −0.291 dB/year, P < 0.001). The average and inferior hemi-macular ganglion cell inner plexiform layer (GCIPL) progression rates were significantly faster in the HNL group than in the LNL group (P < 0.05). Nasalized location of CRVT was an independent predictor of a more rapid VF loss in the central 10° region (P < 0.05).

Netherlands: Black Bear – carbon black from scrap tyres

To compare the variability and ability to detect visual field (VF) progression of 24-2, central 12 locations of the 24-2 and 10-2 VF tests in eyes with abnormal VFs.Retrospective, multisite cohort.A total of 52 806 24-2 and 11 966 10-2 VF tests from 7307 eyes from the Glaucoma Research Network database were analyzed. Only eyes with ≥ 5 visits and ≥ 2 years of follow-up were included.Linear regression models were used to calculate the rates of mean deviation (MD) change (slopes), whereas their residuals were used to assess variability across the entire MD range. Computer simulations (n = 10 000) based on real MD residuals of our sample were performed to estimate power to detect significant progression (P < 5%) at various rates of MD change.Time required to detect progression.For all 3 patterns, the MD variability was highest within the −5 to −20 decibel (dB) range and consistently lower with the 10-2 compared with 24-2 or central 24-2. Overall, time to detect confirmed significant progression at 80% power was the lowest with 10-2 VF, with a decrease of 14.6% to 18.5% when compared with 24-2 and a decrease of 22.9% to 26.5% when compared with central 24-2.Time to detect central VF progression was reduced with 10-2 MD compared with 24-2 and C24-2 MD in glaucoma eyes in this large dataset, in part because 10-2 tests had lower variability. These findings contribute to current evidence of the potential value of 10-2 testing in the clinical management of patients with glaucoma and in clinical trial design.

Effect of Glaucoma Surgery on the Progression Rate and Pattern in Glaucoma Patients With Myopia.

To evaluate the effect of myopia on the changes of visual field (VF) and retinal nerve fiber layer (RNFL) thickness after glaucoma surgery. Patients with primary open-angle glaucoma who underwent glaucoma surgery due to uncontrolled IOP, with at least four VF and optical coherence tomography (OCT) examinations before and after surgery (total of eight VF and OCT examinations), and follow-ups of at least 4 years, were enrolled and classified according to axial length. Disc ovality ratio, degree of disc torsion, and ratio between peripapillary atrophy area and disc area were measured from disc photographs. The rate of change of the VF parameters and RNFL thickness was determined by using a linear regression analysis and compared according to the degree of myopia. A total of 63 eyes with myopia and 46 eyes without myopia were analyzed. The rate of change in the sensitivity of the central VF (within 10° region) and temporal RNFL thickness differed significantly between the myopic and nonmyopic groups (P < 0.01 and P < 0.01, respectively). Axial length (P < 0.01), magnitude of IOP change after surgery (P < 0.01), the presence of postoperative hypertensive phase (P < 0.01), and peripapillary atrophy to disc area ratio (P < 0.01) were significantly related to the change of the central VF and temporal RNFL thickness. Myopic eyes with large peripapillary atrophy relative to the disc area seem to show greater central VF progression and temporal RNFL thinning after glaucoma surgery when they are exposed to large IOP change of glaucoma surgery.

Macular Ganglion Cell Layer Assessment to Detect Glaucomatous Central Visual Field Progression

PurposeTo investigate the use of ganglion cell inner plexiform layer (GC-IPL) thickness, as measured by spectral domain optical coherence tomography, to detect central visual field (VF) progression.MethodsThis study included 384 eyes from 384 patients (219 preperimetric and 165 perimetric glaucomatous eyes; average follow-up, 4.3 years). Photographic assessment of retinal nerve fiber layer (RNFL) and serial VF analysis were performed to detect glaucoma progression in the central (within 10°) area. Study inclusion required at least five serial spectral domain optical coherence tomography exams at different visits. The long-term test-retest variability of average GC-IPL thicknesses was calculated in 110 stable preperimetric glaucomatous eyes. The sensitivity and specificity of GC-IPL measurements for the detection of central VF progression were calculated in an event-based analysis using the calculated variability as a cut-off and were compared with those of central RNFL photographic assessment.ResultsThe intersession test-retest variability, defined as the 95% confidence interval, was 1.76 µm for average GC-IPL thickness. The sensitivity and specificity of the average GC-IPL thickness for detecting central VF progression were 60.7% and 78.9%, respectively. Among six sectors, the inferonasal GC-IPL sector showed the highest sensitivity (53.6%). The sensitivity of the ≥1 sector GC-IPL to detect central VF progression was significantly higher than that of central RNFL photographic progression (p = 0.013). Other GC-IPL parameters showed comparable sensitivity and specificity to detect central VF progression compared with RNFL photographic progression.ConclusionsSerial GC-IPL measurements show comparable performance in the detection of central glaucomatous VF progression to RNFL photographic assessment.

Central Visual Field Progression in Normal-Tension Glaucoma Patients With Autonomic Dysfunction

To investigate the characteristics of visual field (VF) progression in normal-tension glaucoma (NTG) patients with autonomic dysfunction. Forty-eight NTG eyes with more than seven VF tests during at least 5 years of follow-up were analyzed retrospectively. All participants were referred to rheumatology, where they were subjected to heart-rate variability assessment. Patients were classified into the lowest and highest heart-rate variability groups according to the SD value of the qualified normal-to-normal intervals of the heart-rate-variability assessment. The VF was divided into central and peripheral regions and further classified into superior and inferior regions. Groups in the lowest and highest heart-rate variability groups were compared in terms of rates of change in the mean thresholds of each designated region by using a linear mixed model. Potential clinical factors associated with central VF progression were also investigated. The baseline VF showed similar stages of glaucoma damage between the lowest and highest heart-rate variability groups. The mean global rate of VF changes was similar between the two groups. Only the rate of VF changes in the central and superior central regions were significantly different between the lowest heart-rate variability group (-1.16 dB/year in the central region and -1.48 dB/year in the superior central region) and highest heart-rate variability group (-0.52 dB/year in the central region and -0.64 dB/year in the superior central region). Baseline VF pattern SD (β = -1.160, P = 0.008), migraine (β = 1.380, P = 0.040), orthostatic hypotension (β = 1.146, P = 0.023), and lower heart-rate variability (β = -1.516, P = 0.010) were significantly associated with central VF progression. NTG patients with lower heart-rate variability, which reflects autonomic dysfunction with sympathetic predominance, presented faster rate of central VF progression than patients with higher heart-rate variability. Intraocular pressure-independent risk factors, such as migraine, orthostatic hypotension, and autonomic dysfunction, were related to central VF progression.

Characteristics of Visual Field Progression in Medically Treated Normal-Tension Glaucoma Patients with Unstable Ocular Perfusion Pressure

To investigate the characteristics of visual field (VF) progression in medically treated normal-tension glaucoma (NTG) patients (Koreans) with unstable ocular perfusion pressure (OPP). One hundred one eyes of 101 NTG patients followed up for more than 4 years (mean follow-up, 6.2 years ± 12.1 months) were included. Modified Anderson criteria (MC) and linear regression analysis (LA) of VF mean deviation (MD) within the central 10° and 10° to 24° area were assessed for determining VF progression in groups with lowest (LMF) and highest (HMF) 24-hour mean OPP [MOPP = 2/3;(mean arterial pressure - IOP)] fluctuation. Kaplan-Meier analyses were used to compare the elapsed time of confirmed VF progression in the two groups. Hazard ratios (HRs) for the association between clinical risk factors including 24-hour MOPP and central VF progression were obtained by using Cox proportional hazards models. Three of 33 eyes in the LMF progressed, whereas 12 of 34 eyes in the HMF progressed within the central 10° according to the MC; the between-group difference was significant (P = 0.010). By LA within the central 10°, two eyes from the LMF and nine from the HMF groups showed progression (P = 0.025). The HMF showed a greater cumulative probability of central VF progression than the LMF, by both LA and MC (Kaplan-Meier analysis, P = 0.003, 0.015, log-rank test). In multivariate analysis, only 24-hour MOPP fluctuation was significantly associated with central VF progression (P = 0.014). The 24-hour MOPP fluctuation was the most consistent prognostic factor among various IOP, blood pressure, and clinical factors for central VF glaucomatous progression in our series of NTG eyes.