Elsevier

Ophthalmology

Volume 109, Issue 12, December 2002, Pages 2232-2240
Ophthalmology

Article for CME credit
Rate and pattern of visual field decline in primary open-angle glaucoma

Presented in part at the Association for Research in Vision and Ophthalmology meeting, Fort Lauderdale, Florida, April 2001.
https://doi.org/10.1016/S0161-6420(02)01248-4Get rights and content

Abstract

Purpose

To study the rate and pattern of visual field decline in primary open-angle glaucoma.

Design

Retrospective observational case series.

Participants

Forty eyes of 40 patients with primary open-angle glaucoma that were followed longitudinally with serial Goldmann visual fields for a minimum period of 8 years in an academic institution. Eyes with any other ocular disease except for mild cataract were excluded.

Methods

Visual fields obtained with worse than 20/50 Snellen visual acuity from cataract were excluded from analysis. In the remainder (671 Goldmann visual fields), the I4e isopter was quantified manually using a grid template previously described by Esterman. The visual field was divided into central and peripheral, superior and inferior, and nasal and temporal regions, all centered at the blind spot. The rate of visual field decline was estimated for each visual field region (including the four quadrants: superonasal [SN], superotemporal [ST], inferotemporal [IT], and inferonasal [IN]) using linear regression. Asymmetry of visual field progression was determined by comparing the rates of progression among the four quadrants. Pertinent clinical factors were evaluated for association with the asymmetry of visual field progression.

Main outcome measures

Rates of visual field decline for the entire visual field and each region. Long-term clinical outcome measures, including visual acuity, cataract and cup-to-disc ratio progression, intraocular pressures, and medical and surgical interventions were also studied.

Results

The rate of visual field change was −1.3% per year for the entire visual field. The rates of visual field section change (in % per year) were −1.3 (central), −1.4 (peripheral), −1.5 (superior), −1.2 (inferior), −1.4 (nasal), −1.2 (temporal), −1.8 (SN), −1.3 (IT), −1.2 (IN), and −1.1 (ST). About half the patients showed symmetric visual field decline, whereas others showed a more asymmetric pattern. Asymmetric visual field progression was associated with the presence of disc hemorrhage, overall rate of visual field progression, and surgical intervention for glaucoma.

Conclusions

In this group of selected patients with primary open-angle glaucoma with a long-term follow-up, all sections of the visual field declined over time. Disc hemorrhage was associated with more asymmetric visual field progression, implicating focal damage to the optic disc.

Section snippets

Patients

Institutional review board/ethics committee approval was obtained. Patients who had been followed since 1972 in the Department of Ophthalmology and Visual Sciences at the University of Iowa were studied. The inclusion criteria for the study were the following: (1) Diagnosis of primary open-angle glaucoma, defined as normal-appearing (open) iridocorneal angles, peak intraocular pressure (IOP) of > 21 mmHg, characteristic glaucomatous optic disc cupping with or without corresponding visual field

Results

Of 2893 POAG patients identified in our database, 77 patients who had a minimum of 8 years of follow-up with serial Goldmann visual fields were initially chosen. Of the 77 patients, we studied 40 eyes of 40 POAG patients that satisfied the inclusion and exclusion criteria. The patient characteristics are shown in Table 1. All 40 patients were white, reflecting the underlying population of Iowa (98% white). At the beginning of the study, the patient’s mean age was 64.3 ± 8.3 years (range,

Discussion

In POAG patients who are regularly followed and treated, it seems the rate of visual field decline is slow. In this study of 40 POAG patients with a mean follow-up of 15.2 years, this rate is estimated at −1.3% per year based on the I4e Goldmann visual field isopter. Using automated perimetry, others2 have estimated the rate of visual field decline in POAG to be −1.3% per year (the value derived from their Tables 4 and 5), remarkably similar to our results. When the visual field was divided

References (13)

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Manuscript no. 210935.

Supported in part by the Otsuka Research Award from the American Glaucoma Society, San Francisco, California; Shaffer International Research Fellowship from the Glaucoma Research Foundation, San Francisco, California; unrestricted grant from Research to Prevent Blindness, New York, New York; NEI research grants #EY-1151 and #EY-3330; SSH is a Research to Prevent Blindness Senior Scientific Investigator.

The authors have no commercial interest in any of the products mentioned in the manuscript.

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