Rate Of Visual Field Loss Research Articles

Frequency of Visual Fields Needed to Detect Glaucoma Progression: A Computer Simulation Using Linear Mixed Effects Model.

Irregular visual field test frequency at relatively short intervals initially and longer intervals later on in the disease provided acceptable results in detecting glaucoma progression. It is challenging to maintain a balance between the frequency of visual field testing and the long-term costs that may result from insufficient treatment of glaucoma patients. This study aims to simulate real-world circumstances of visual field data to determine the optimum follow-up scheme for the timely detection of glaucoma progression using a linear mixed effects model (LMM). An LMM with random intercept and slope was used to simulate the series of mean deviation sensitivities over time. A cohort study including 277 glaucoma eyes that were followed for 9.0±1.2 years was used to derive residuals. Data were generated from patients with early-stage glaucoma having various regular and irregular follow-up scenarios and different rates of visual field loss. For each condition, 10,000 series of eyes were simulated, and one confirmatory test was conducted to identify progression. By doing one confirmatory test, the percentage of incorrect progression detection decreased considerably. The time to detect progression was shorter for eyes with an evenly spaced 4-monthly schedule, particularly in the first 2 years. From then onward, results from twice-a-year testing were similar to results from examinations scheduled 3 times per year. Irregular visual field test frequency at relatively short intervals initially and longer intervals later on in the disease provided acceptable results in detecting glaucoma progression. This approach could be considered for improving glaucoma monitoring. Moreover, simulating data using LMM may provide a better estimate of the disease progression time.

Rates of Visual Field Change in Eyes With Optic Disc Drusen.

Optic disc drusen (ODD) are calcified deposits in the prelaminar portion of the optic nerve head. Although often asymptomatic, these deposits can cause progressive visual field defects and vision loss. The purpose of this study was to evaluate rates of functional loss in eyes with ODD and to investigate risk factors associated with rates of visual field progression. This was a retrospective cohort study including 65 eyes of 43 patients with ODD from the Duke Ophthalmic Registry. All eyes had at least 12 months of follow-up and at least 3 reliable standard automated perimetry (SAP) tests. Linear mixed models were used to estimate rates of SAP mean deviation (MD) loss over time. Univariable and multivariable models were used to assess the effect of clinical variables and intraocular pressure (IOP) on rates of change. Subjects were followed for an average of 7.6 ± 5.3 years. The mean rate of SAP MD change was -0.23 ± 0.26 dB/year, ranging from -1.19 to 0.13 dB/year. Fifty-seven eyes (87.7%) had slow progression (slower than -0.5 dB/year), 6 eyes (9.2%) had moderate progression (between -0.5 dB/year and -1 dB/year), and 2 eyes (3.1%) had fast progression (faster than -1 dB/year). In multivariable models, older age and worse SAP MD at baseline were significantly associated with faster rates of change. Mean IOP was not associated with faster rates of MD change in both univariable and multivariable analyses. Most eyes with ODD had slow rates of visual field loss over time. Age and baseline severity were significantly associated with faster rates of visual field loss.

Prophylaxis with intraocular pressure lowering medication and glaucomatous progression in patients receiving intravitreal anti-VEGF therapy.

To investigate whether pretreatment with pressure-lowering medication prior to anti-vascular endothelial factor (VEGF) injections had an effect on glaucomatous progression in patients with preexisting glaucoma or ocular hypertension (OHT). A total of 66 eyes from 54 patients with a preexisting diagnosis of glaucoma or OHT, treated with six or more anti-VEGF injections were selected for chart review. Primary outcome measures were rate of visual field loss in dB/year, rate of change in retinal nerve fiber layer (RNFL) thickness in microns/year, and need for additional glaucoma intervention. The number of eyes requiring additional glaucoma medication was 5 of 20 (25.0%) and 14 of 46 (30.4%) for the pretreated and non-pretreated groups, respectively. The number of eyes requiring glaucoma laser or surgery was 4 of 20 (20.0%) and 13 of 46 (28.3%) for the pretreated and non-pretreated groups, respectively. Estimated mean rate of pattern standard deviation decline was not significant in either group (P>0.073), with no difference between groups (P=0.332). Although both groups showed significant RNFL change from baseline (P<0.011), no difference was detected between groups (P=0.467). Pretreatment has no detectable effect on structural or functional glaucomatous progression. Patients receiving repeated injections may be at risk for glaucomatous complications requiring invasive intervention.

Laser trabeculoplasty for open-angle glaucoma and ocular hypertension.

Laser trabeculoplasty for open-angle glaucoma and ocular hypertension.

Association of Initial Optical Coherence Tomography Angiography Vessel Density Loss With Faster Visual Field Loss in Glaucoma

Rapid vessel density loss during an initial follow-up period may be associated with the rates of visual field loss over time. To evaluate the association between the rate of vessel density loss during initial follow-up and the rate of visual field loss during an extended follow-up period in patients suspected of having glaucoma and patients with primary open-angle glaucoma. This retrospective cohort study assessed 124 eyes (86 with primary open-angle glaucoma and 38 suspected of having glaucoma) of 82 patients who were followed up at a tertiary glaucoma center for a mean of 4.0 years (95% CI, 3.9-4.1 years) from January 1, 2015, to February 29, 2020. Data analysis for the current study was undertaken in March 2021. The rate of vessel density loss was derived from macular whole-image vessel density values from 3 optical coherence tomography angiography scans early during the study. The rate of visual field loss was calculated from visual field mean deviation during the entire follow-up period after the first optical coherence tomography angiography visit. Linear mixed-effects models were used to estimate rates of change. A total of 124 eyes from 82 patients (mean [SD] age, 69.2 [10.9] years; 41 female [50.0%] and 41 male [50.0%]; and 20 African American [24.4%], 10 Asian [12.2%], 50 White [61.0%], and 2 other race or ethnicity [2.4%]) were assessed. The annual rate of vessel density change was -0.80% (95% CI, -0.88% to -0.72%) during a mean initial follow-up of 2.1 years (95% CI, 1.9-2.3 years). Eyes with annual rates of vessel density loss of -0.75% or greater (n = 62) were categorized as fast progressors, and eyes with annual rates of less than -0.75% (n = 62) were categorized as slow progressors. The annual rate of visual field loss was -0.15 dB (95% CI, -0.29 to -0.01 dB) for the slow optical coherence tomography angiography progressors and -0.43 dB (95% CI, -0.58 to -0.29 dB) for the fast optical coherence tomography angiography progressors (difference, -0.28 dB; 95% CI, -0.48 to -0.08 dB; P = .006). The fast optical coherence tomography angiography progressor group was associated with the faster overall rate of visual field loss in a multivariable model after adjusting to include concurrent visual field mean deviation rate (-0.17 dB; 95% CI, -0.33 to -0.01 dB; P = .04). The findings of this cohort study suggest that faster vessel density loss during an initial follow-up period was associated with faster concurrent and subsequent rates of visual field loss during an extended period.

Corneal hysteresis: ready for prime time?

This review summarizes recent findings on corneal hysteresis, a biomechanical property of the cornea. Corneal hysteresis measurements can be easily acquired clinically and may serve as surrogate markers for biomechanical properties of tissues in the back of the eye, like the lamina cribrosa and peripapillary sclera, which may be related to the susceptibility to glaucomatous damage. Several studies have provided evidence of the associations between corneal hysteresis and clinically relevant outcomes in glaucoma. Corneal hysteresis has been shown to be predictive of glaucoma development in eyes suspected of having the disease. For eyes already diagnosed with glaucoma, lower corneal hysteresis has been associated with higher risk of progression and faster rates of visual field loss over time. Such associations appear to be stronger than those for corneal thickness, suggesting that corneal hysteresis may be a more important predictive factor. Recent evidence has also shown that cornealcorrected intraocular pressure measurements may present advantages compared to conventional Goldmann tonometry in predicting clinically relevant outcomes in glaucoma. Given the evidence supporting corneal hysteresis as an important risk factor for glaucoma development and its progression, practitioners should consider measuring corneal hysteresis in all patients at risk for glaucoma, as well as in those already diagnosed with the disease.

Rates of Glaucoma Progression Derived from Linear Mixed Models Using Varied Random Effect Distributions.

PurposeTo compare the ability of linear mixed models with different random effect distributions to estimate rates of visual field loss in glaucoma patients.MethodsEyes with five or more reliable standard automated perimetry (SAP) tests were identified from the Duke Glaucoma Registry. Mean deviation (MD) values from each visual field and associated timepoints were collected. These data were modeled using ordinary least square (OLS) regression and linear mixed models using the Gaussian, Student's t, or log-gamma (LG) distributions as the prior distribution for random effects. Model fit was compared using the Watanabe–Akaike information criterion (WAIC). Simulated eyes of varying initial disease severity and rates of progression were created to assess the accuracy of each model in predicting the rate of change and likelihood of declaring progression.ResultsA total of 52,900 visual fields from 6558 eyes of 3981 subjects were included. Mean follow-up period was 8.7 ± 4.0 years, with an average of 8.1 ± 3.7 visual fields per eye. The LG model produced the lowest WAIC, demonstrating optimal model fit. In simulations, the LG model declared progression earlier than OLS (P < 0.001) and had the greatest accuracy in predicted slopes (P < 0.001). The Gaussian model significantly underestimated rates of progression among fast and catastrophic progressors.ConclusionsLinear mixed models using the LG distribution outperformed conventional approaches for estimating rates of SAP MD loss in a population with glaucoma.Translational RelevanceUse of the LG distribution in models estimating rates of change among glaucoma patients may improve their accuracy in rapidly identifying progressors at high risk for vision loss.

Rapid initial OCT RNFL thinning is predictive of faster visual field loss during extended follow-up in glaucoma

To investigate the relationship between the rate of retinal nerve fiber layer (RNFL) loss during initial follow-up and the magnitude of associated visual field loss during an extended follow-up period. Retrospective cohort study. A total of 1,150 eyes of 839 glaucoma patients extracted from the Duke Glaucoma Registry. Rates of RNFL loss were obtained from global RNFL thickness values of the first 5 optical coherence tomography (OCT) scans. Rates of visual field loss were assessed using standard automated perimetry mean deviation (SAP MD) during the entire follow-up period. Joint longitudinal mixed effects models were used to estimate rates of change. Eyes were categorized as fast, moderate or slow progressors based on rates of RNFL loss, with cutoffs of ≤-2 µm/year, -2 to -1 µm/year and ≥-1 µm/year, respectively. Univariable and multivariable regressions were completed to identify significant predictors of SAP MD loss. The rate of RNFL change was -0.76±0.85 µm/y during initial follow-up, which occurred over 3.7±1.5 years. 765 (66%) eyes were slow, 328 (29%) moderate, and 57 (5%) fast progressors, with rates of RNFL thinning of -0.36±0.54 µm/year, -1.34±0.25 µm/year, and -2.87±1.39 µm/year respectively. The rates of SAP MD loss among slow, moderate, and fast OCT progressors were -0.16±0.35 dB/y, -0.32±0.43 dB/y, and -0.71±0.65 dB/y respectively over the extended follow-up period of 6.1±1.9 years (P<0.001). Age, OCT progressor group, and concurrent SAP rate were all significantly associated with the overall rate of SAP MD loss in a multivariable model (all P<0.001). Rapid RNFL thinning during an initial follow-up period was predictive of concurrent and subsequent rates of visual field decline over an extended period.

An Increased Choroidal Microvasculature Dropout Size is Associated With Progressive Visual Field Loss in Open-Angle Glaucoma

To investigate whether the choroidal microvasculature dropout (CMvD) increases in size over time among open-angle glaucoma (OAG) eyes presenting with CMvD at baseline and evaluate the association between longitudinal CMvD size increases and subsequent visual field (VF) progression. Retrospective cohort study. This study enrolled 101 eyes from 101 consecutive patients with OAG with a localized CMvD and glaucomatous VF defects at baseline and a minimum 2-year follow-up. The angular circumference (AC) of the CMvD was determined from choroidal layer images using optical coherence tomography angiography at the baseline and final follow-up. Demographic and ocular characteristics, including the rate of retinal nerve fiber layer thickness loss and amount of CMvD AC increase during follow-up, were compared between OAG eyes with and without VF progression. Cox proportional hazard analysis was performed to identify the clinical factors associated with VF progression. The relationships between CMvD angular enlargement during follow-up and clinical factors were assessed. CMvD angular enlargement was found in 21.8% of patients while VF progression was observed in 26.7% of the OAG eyes with CMvD during a mean 2.52-year follow-up. OAG eyes with VF progression showed a significantly greater CMvD angular enlargement. A larger increase in the CMvD AC was an independent predictor of VF progression. CMvD AC changes were significantly correlated with the rates of VF deterioration. VF progression is significantly associated with a greater longitudinal increase in the CMvD AC in OAG eyes with CMvD. CMvD AC changes have significant correlations with the rate of VF loss.

The Relationship Between Asymmetries of Corneal Properties and Rates of Visual Field Progression in Glaucoma Patients

The purpose of this study was to investigate the relationship between asymmetries in rates of glaucoma progression and asymmetries of corneal properties between eyes of subjects with primary open-angle glaucoma. This prospective study followed 126 binocular subjects with glaucoma for an average of 4.3±0.8 years. CH was measured at baseline using the Ocular Response Analyzer. Standard automated perimetry (SAP) and intraocular pressure were measured at baseline and every 6 months. Rates of visual field progression were calculated using ordinary least square regression of SAP mean deviation (MD) values over time for each eye. Eyes were defined as "better" and "worse" based on the slopes of SAP MD. Pearson correlation test, and univariable and multivariable regression models were used to investigate the relationship between inter-eye asymmetry in CH and central corneal thickness and inter-eye differences in rates of visual field progression. Only asymmetry of CH was significantly associated with the asymmetry in SAP MD rates of change between eyes (r=0.22; P=0.01). In a multivariable model adjusting for age, race, central corneal thickness, mean intraocular pressure and baseline disease severity, CH asymmetry remained significantly associated with asymmetric progression (P=0.032). CH asymmetry between eyes was associated with asymmetry on rates of visual field change, providing further support for the role of CH as a risk factor for glaucoma progression.

Effects of Intravitreal Anti-VEGF Therapy on Glaucoma-like Progression in Susceptible Eyes.

The purpose of this study was to investigate whether repeated anti-VEGF injections accelerate structural and functional glaucomatous change in eyes with preexisting glaucoma or OHT. This is a retrospective, observational study of injected and noninjected fellow eyes. A total of 28 patients with preexisting glaucoma or OHT, who received ≥6 unilateral anti-VEGF injections for concurrent neovascular retinal disease, were selected for chart review. Primary outcome measures were rate of visual field loss in dB/year, rate of change in retinal nerve fiber layer (RNFL) thickness in microns/year, and need for additional glaucoma medications, surgery, or laser. The number of eyes requiring additional glaucoma surgery or laser was 8 of 28 (28.6%) for the injected group and 2 of 28 (7.1%) for the noninjected group. A significantly greater proportion of injected eyes required invasive glaucoma intervention (P=0.034). Average rate of decline in mean deviation and change in pattern standard deviation were both significantly greater in injected eyes (P=0.029; P=0.019). Estimated mean rate of global retinal nerve fiber layer change was -4.27 µm/y for the injected group and -1.17 µm/y for the noninjected group and was significant only for injected eyes (P=0.014). Only the superior quadrant exhibited thinning that was significantly different between groups (P=0.030). Intravitreal injections were associated with accelerated functional and structural glaucoma-like change in susceptible eyes. Clinicians should assess the need for glaucoma medications or other interventions over the course of anti-VEGF therapy.

Evaluating the Impact of Uveitis on Visual Field Progression Using Large-Scale Real-World Data

To compare rates of visual field (VF) loss in uveitis patients with glaucoma against patients with primary open-angle glaucoma (POAG) and explore the association between intraocular pressure (IOP) and rate of VF loss. Retrospective cohort study. Anonymized VFs and IOP measurements extracted from the electronic medical records of 5 regionally different glaucoma clinics in England. A total of 205 eyes with diagnosis of uveitis plus glaucoma were compared with 4600 eyes with POAG only. Minimum inclusion criteria were ≥4 visits within a 4-year window. Relative risk (RR) of being a "rapid progressor" (mean deviation [MD] loss ≥1.5 dB/year) was calculated. A mixed-effects model (MEM) and a pointwise VF progression analysis of pattern deviation were used to confirm differences between the groups. Longitudinal IOP mean, range, and variability were compared with rate of VF progression. Median (interquartile range) baseline MD in the uveitis and POAG groups was -3.8 (-8.7, -1.5) dB and -3.1 (-6.6, -1.2) dB, respectively. The uveitis and POAG groups had 23 of 205 (11%) and 331 of 4600 (7%) "rapidly progressing" eyes, respectively. Age-adjusted RR for "rapid progression" in uveitic vs POAG eyes was 1.9 (95% confidence interval: 1.8-2.0). The MEM confirmed that uveitic eyes (-0.49 dB/year) showed higher rates of VF progression than the POAG group (-0.37 dB/year; P < .01). IOP range and variability were higher in the "rapidly progressing" uveitic eyes. Our analysis suggests that VF loss occurs faster in glaucoma patients with uveitis than those without uveitis. The risk of progressing rapidly in glaucoma with uveitis is almost double than in those without uveitis. Early identification of "rapid progressors" may enable targeted intervention to preserve visual function in this high-risk group.

Extending the Spectrum of EYS-Associated Retinal Disease to Macular Dystrophy.

To assess the phenotypic variability and natural course of inherited retinal diseases (IRDs) caused by EYS mutations. Multiethnic cohort study (N = 30) with biallelic EYS variants from a clinical IRD database (retinitis pigmentosa [RP], N = 27; cone-rod dystrophy [CRD], N = 1; and macular dystrophy, N = 2). In vitro minigene splice assay was performed to determine the effect on EYS pre-mRNA splicing of the c.1299+5_1299+8del variant in macular dystrophy patients. We found 27 different EYS variants in RP patients and 7 were novel. The rate of visual field loss of the V4e isopter area was -0.84 ± 0.44 ln(deg2) per year, and the rate of visual acuity loss was 0.75 Early Treatment Diabetic Retinopathy Study letters per year. Ellipsoid zone width was correlated with area of the hyperautofluorescent ring, with rs = 0.78 and P < 0.001. Rate of decline in ellipsoid zone width was -57 ± 17 μm per year (P < 0.01) (n = 14) or -3.69% ± 0.51% from baseline per year (P < 0.001). An isolated CRD patient carried a homozygous EYS variant (c.9405T>A), previously identified in RP patients. Two siblings with macular dystrophy carried compound heterozygous EYS variants: c.1299+5_1299+8del and c.6050G>T. The former was novel and shown to result in skipping of exon 8, and the latter was a known RP variant. We report on EYS-associated macular dystrophy, extending the spectrum of EYS-associated IRDs. We observed heterogeneity between RP patients in age of onset and disease progression. Identical EYS variants were found in cases with RP, CRD, and macular dystrophy. Screening for EYS variants in CRD and macular dystrophy patients might increase the diagnostic yield in previously unsolved cases.

Association between Rates of Visual Field Progression and Intraocular Pressure Measurements Obtained by Different Tonometers

To investigate the associations between intraocular pressure (IOP) measurements obtained by different tonometric methods and rates of visual field loss in a cohort of patients with glaucoma followed over time. Prospective, observational cohort study. This study included 213 eyes of 125 glaucomatous patients who were followed for an average of 2.4±0.6 years. At each visit, IOP measurements were obtained using Goldmann applanation tonometry (GAT), the Ocular Response Analyzer (ORA) (Reichert, Inc., Depew, NY), corneal-compensated IOP (IOPcc), and the ICare Rebound Tonometer (RBT) (Tiolat, Oy, Helsinki, Finland). Rates of visual field loss were assessed by standard automated perimetry (SAP) mean deviation (MD). Linear mixed models were used to investigate the relationship between mean IOP by each tonometer and rates of visual field loss over time, while adjusting for age, race, central corneal thickness, and corneal hysteresis. Strength of associations (R2) between IOP measurements from each tonometer and rates of SAP MD change over time. Average values for mean IOP over time measured by GAT, ORA, and RBT were 14.4±3.3, 15.2±4.2, and 13.4±4.2 mmHg, respectively. Mean IOPcc had the strongest relationship with SAP MD loss over time (R2= 24.5%) and was significantly different from the models using mean GAT IOP (R2= 11.1%; 95% confidence interval [CI] of the difference, 6.6-19.6) and mean RBT IOP (R2= 5.8%; 95% CI of the difference, 11.1-25.0). Mean ORA IOPcc was more predictive of rates of visual field loss than mean IOP obtained by GAT or RBT. By correcting for corneal-induced artifacts, IOPcc measurements may present significant advantages for predicting clinically relevant outcomes in patients with glaucoma.

Distribution and Rates of Visual Field Loss across Different Disease Stages in Primary Open-Angle Glaucoma

To identify patterns and rates of visual field (VF) loss in primary open-angle glaucoma (POAG) across different levels of severity. Retrospective, observational case series. Visual fields of 278 eyes of 139 patients with POAG (9 years of follow-up with ∼17 visits) from the Rotterdam Eye Hospital in The Netherlands were analyzed to identify patterns and rates of VF loss. Rate of VF decline for the entire VF, each region, and test point. Hemifield asymmetric rate if VF decline for each region and test point. Total deviation (TD) values were extracted from the Humphrey VF Analyzer (Carl Zeiss Meditec, Dublin, CA). Eyes were stratified into 3 glaucoma stages by means of the mean deviation (MD): better than-6 decibels (dB), worse than-6 dB and better than-12 dB, and worse than-12 dB. Each hemifield was divided into 5 regions according to the Glaucoma Hemifield Test (GHT): central, paracentral, nasal, and peripheral arcuates 1 and 2. Point-wise and region-wise asymmetric patterns of VF loss and rate of VF loss were identified by comparing the values in the superior hemifield and the inferior hemifield at each severity level using a generalized estimating equation. The mean age of the patients was 60.2±10.3 years (mean ± standard deviation [SD]). The rate of MD loss, for all eyes taken together, was-0.11 dB/year. In the cross-sectional analysis, in eyes in the early and moderate stages, central and peripheral arcuate 2 regions in the superior hemifield were worse than their inferior counterpart, whereas in the advanced stage all GHT regions in the superior hemifield were significantly worse than the corresponding regions in the inferior hemifield (P ≤ 0.05). In the longitudinal analysis, there was no significant difference in the rate of VF loss between the GHT regions in the superior and inferior hemifields. Our findings suggest that in POAG, VF damage is worse in the superior hemifield than in the inferior hemifield.

Progression of Primary Open-Angle Glaucoma in Diabetic and Nondiabetic Patients

To compare the rates of visual field (VF) loss and retinal nerve fiber layer (RNFL) thinning in primary open-angle glaucoma (POAG) patients with or without type 2 diabetes mellitus (DM). Cohort study. A total of 197 eyes (55 eyes of 32 POAG patients with DM in POAG/DM group and 142 eyes of 111 age-matched POAG patients without DM in POAG/DM- group) were included from the Diagnostic Innovations in Glaucoma Study (DIGS). Type 2 DM participants were defined by self-report of DM history and use of antidiabetic medication. The rates of VF loss and RNFL loss were compared in POAG eyes with and without DM using univariate and multivariable mixed-effects models. The median (interquartile range) follow-up was 5.7 years (4.0, 6.4). The mean rate of global RNFL loss in the POAG/DM group was 2-fold slower than in the POAG/DM- group overall (-0.40μm/year vs-0.83μm/year, respectively P= .01). Although a slower rate of VF mean deviation and pattern standard deviation loss was found in the POAG/DM group compared to the POAG/DM- group, the difference was not statistically significant. POAG patients with treated type 2 DM, who had no detectable diabetic retinopathy, had significantly slower rates of RNFL thinning compared to those without diagnosed DM.

Is Obstructive Sleep Apnea Associated With Progressive Glaucomatous Optic Neuropathy?

The purpose of this study was to evaluate the relationship between obstructive sleep apnea syndrome (OSAS) and glaucoma progression, and to examine the correlation between OSAS severity and rate of visual field (VF) loss. Patients with concurrent diagnoses of open-angle glaucoma and OSAS between 2010 and 2016 were identified. Enrollment criteria consisted of glaucomatous optic neuropathy and VF loss, ≥5 reliable VFs, ≥2 years of follow-up, and polysomnography (PSG) within 12 months of final VF. PSG parameters including apnea-hypopnea index (AHI) and oxygen saturation (SpO2) were collected. Eyes were classified as "progressors" or "nonprogressors" based upon event analysis using Glaucoma Progression Analysis criteria. Two-tailed t test comparisons were performed, and correlations between rates of VF loss and PSG parameters were assessed. A total of 141 patients with OSAS and glaucoma were identified. Twenty-five patients (age 67.9±7.6 y) with OSAS (8 mild, 8 moderate, 9 severe) were enrolled. Eleven eyes (44%) were classified as progressors, and had more severe baseline VF loss (P=0.03). Progressors and nonprogressors had nonsignificantly different (P>0.05) age (69.9±8.7 vs. 66.4±6.6 y), follow-up (4.4±0.7 vs. 4.3±1.0 y), intraocular pressure (13.1±2.8 vs. 14.9±2.5 mm Hg), mean ocular perfusion pressure (49.7±5.5 vs. 48.8±9.0 mm Hg), AHI (31.3±18.6 vs. 26.4±24.0), body-mass index (27.8±5.5 vs. 28.8±5.6), and SpO2 (94.1±1.6% vs. 94.0±1.6%). AHI was not correlated with slopes of VF mean deviation (r, -0.271; P, 0.190) or pattern standard deviation (r, 0.211; P, 0.312), and no substantial increase in risk of progression was found with increase in AHI. This study does not support a relationship between OSAS and glaucomatous progression. No correlation was observed between OSAS severity and rate of VF loss.

Predicting Vision-Related Disability in Glaucoma

To present a new methodology for investigating predictive factors associated with development of vision-related disability in glaucoma. Prospective, observational cohort study. Two hundred thirty-six patients with glaucoma followed up for an average of 4.3±1.5 years. Vision-related disability was assessed by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) at baseline and at the end of follow-up. A latent transition analysis model was used to categorize NEI VFQ-25 results and to estimate the probability of developing vision-related disability during follow-up. Patients were tested with standard automated perimetry (SAP) at 6-month intervals, and evaluation of rates of visual field change was performed using mean sensitivity (MS) of the integrated binocular visual field. Baseline disease severity, rate of visual field loss, and duration of follow-up were investigated as predictive factors for development of disability during follow-up. The relationship between baseline and rates of visual field deterioration and the probability of vision-related disability developing during follow-up. At baseline, 67 of 236 (28%) glaucoma patients were classified as disabled based on NEI VFQ-25 results, whereas 169 (72%) were classified as nondisabled. Patients classified as nondisabled at baseline had 14.2% probability of disability developing during follow-up. Rates of visual field loss as estimated by integrated binocular MS were almost 4 times faster for those in whom disability developed versus those in whom it did not (-0.78±1.00 dB/year vs.-0.20±0.47 dB/year, respectively; P < 0.001). In the multivariate model, each 1-dB lower baseline binocular MS was associated with 34% higher odds of disability developing over time (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.06-1.70; P= 0.013). In addition, each 0.5-dB/year faster rate of loss of binocular MS during follow-up was associated with a more than 3.5 times increase in the risk of disability developing (OR, 3.58; 95% CI, 1.56-8.23; P= 0.003). A new methodology for classification and analysis of change in patient-reported quality-of-life outcomes allowed construction of models for predicting vision-related disability in glaucoma.

The association between retinal vein pulsation pressure and optic disc haemorrhages in glaucoma.

PurposeTo explore the potential relationship between optic disc haemorrhage, venous pulsation pressure (VPP), ocular perfusion pressures and visual field change in glaucomatous and glaucoma suspect eyes.Materials and methodsThis prospective observational study examined 155 open angle glaucoma or glaucoma suspect eyes from 78 patients over 5 years. Patients were followed with 3 monthly non-mydriatic disc photographs, 6 monthly standard automated perimetry and annual ophthalmodynamometry. The number of disc haemorrhages in each hemidisc was counted across the study period. Visual field rate of change was calculated using linear regression on the sensitivity of each location over time, then averaged for the matching hemifield. VPP and central retinal artery diastolic pressure (CRADP) were calculated from the measured ophthalmodynanometric forces (ODF). The difference between brachial artery diastolic pressure (DiastBP) and CRADP was calculated as an index of possible flow pathology along the carotid and ophthalmic arteries.ResultsMean age of the cohort was 71.9 ± 7.3 Years. 76 out of 155 eyes (49%) followed for a mean period of 64.2 months had at least 1 disc haemorrhage. 62 (81.6%) of these 76 eyes had recurrent haemorrhages, with a mean of 5.94 recurrences over 64.2 months. Using univariate analysis, rate of visual field change (P<0.0001), VPP (P = 0.0069), alternative ocular perfusion pressure (CRADP–VPP, P = 0.0036), carotid resistance index (DiastBP–CRADP, P = 0.0108) and mean brachial blood pressure (P = 0.0203) were significantly associated with the number of disc haemorrhages. Using multivariate analysis, increased baseline visual field sensitivity (P = 0.0243, coefficient = 0.0275) was significantly associated with disc haemorrhage, in conjunction with higher VPP (P = 0.0029, coefficient = 0.0631), higher mean blood pressure (P = 0.0113, coefficient = 0.0190), higher carotid resistance index (P = 0.0172, coefficient = 0.0566), and rate of visual field loss (P<0.0001, coefficient = -2.0695).ConclusionsHigher VPP was associated with disc haemorrhage and implicates the involvement of venous pathology, but the effect size is small. Additionally, a greater carotid resistance index suggests that flow pathology in the ophthalmic or carotid arteries may be associated with disc haemorrhage.

Visual Field Progression in Patients with Primary Angle-Closure Glaucoma Using Pointwise Linear Regression Analysis

To evaluate visual field (VF) progression and rate of glaucomatous VF loss in patients with primary angle-closure glaucoma (PACG) using pointwise linear regression (PLR) trend analysis. Clinic-based retrospective study. Primary angle-closure glaucoma patients with 5 or more reliable VF tests and with 5 years or more of follow-up. Visual field progression was assessed by PROGRESSOR software version 3.7 (Medisoft, Leeds, United Kingdom) and was defined by the presence of at least 2 adjacent testing points located within the same hemifield that showed progression with a change of -1 dB/year or more (P < 0.01) for inner points or -2 dB/year or more (P < 0.01) for edge points. We also performed a logistic regression analysis to determine the variables associated with rapid progression (defined as mean slope of progressing points ≥-1.5 dB/year). Visual field progression and rate of VF loss. Of the 1296 patients who were assessed, 398 (30.7%) fulfilled the inclusion criteria of 5 or more VFs and 5 years or more of follow-up. Visual field progression was observed in 63 of 398 eyes (15.8%) according to the PLR criteria. The overall mean rate of VF change for these patients was -0.12±0.51 dB/year over a mean follow-up period of 10.4±3.7 years. There were no significant differences in the age, gender distribution, follow-up duration, or number of VFs between those who showed progression and those who did not (all P > 0.05). The most common sector of VF progression was the superior arcuate area (65%). Rapid progression was found in 36 patients (57%). Multiple logistic regression analysis revealed older age and higher vertical cup-to-disc ratio (VCDR) at presentation as predictors of rapid progression (all P < 0.005) in the progressing group (n= 63). In patients with PACG being managed in a hospital setting, VF progression was noted in 15.8%, and the overall rate of VF loss was -0.12±0.51 dB/year. The superior arcuate was the most common sector of progression. Older age and higher VCDR at presentation were associated with rapid progression.