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Incidence and rates of visual field progression after longitudinally measured optic disc change in glaucoma.

Abstract：

OBJECTIVE:To determine whether glaucoma patients with progressive optic disc change have subsequent visual field progression earlier and at a faster rate compared with those without disc change. DESIGN:Prospective, longitudinal, cohort study. PARTICIPANTS AND CONTROLS:Eighty-one patients with open-angle glaucoma. METHODS:Patients underwent confocal scanning laser tomography and standard automated perimetry every 6 months. The complete follow-up was divided into initial and subsequent periods. Two initial periods-first 3 years (Protocol A) and first half of the total follow-up (Protocol B)-were used, with the respective remainder being the subsequent follow-up. Disc change during the initial follow-up was determined with liberal, moderate, or conservative criteria of the Topographic Change Analysis. Subsequent field progression was determined with significant pattern deviation change in >or=3 locations (criterion used in the Early Manifest Glaucoma Trial). As a control analysis, field change during the initial follow-up was determined with significant pattern deviation change in >or=1, >or=2, or >or=3 locations. MAIN OUTCOME MEASURES:Survival time to subsequent field progression, rates of mean deviation (MD) change, and positive and negative likelihood ratios. RESULTS:The median (interquartile range) total follow-up was 11.0 (8.0-12.0) years with 22 (18-24) examinations. More patients had disc changes during the initial follow-up compared with field changes. The mean time to field progression was consistently shorter (protocol A, 0.8-1.7 years; protocol B, 0.3-0.7 years) in patients with prior disc change. In the control analysis, patients with prior field change had statistically earlier subsequent field progression (protocol A, 2.9-3.0 years; protocol B, 0.7-0.9). Similarly, patients with either prior disc or field change always had worse mean rates of subsequent MD change, although the distributions overlapped widely. Patients with subsequent field progression were up to 3 times more likely to have prior disc change compared with those without, and up to 5 times more likely to have prior field change compared with those without. CONCLUSIONS:Longitudinally measured optic disc change is predictive of subsequent visual field progression and may be an efficacious end point for functional outcomes in clinical studies and trials in glaucoma.

journal_name

Ophthalmology

journal_title

Ophthalmology

authors

Chauhan BC,Nicolela MT,Artes PH

doi

10.1016/j.ophtha.2009.04.031

subject

Has Abstract

pub_date

2009-11-01 00:00:00

pages

2110-8

issue

eissn

0161-6420

issn

1549-4713

pii

S0161-6420(09)00417-5

journal_volume

116

pub_type

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Incidence and rates of visual field progression after longitudinally measured optic disc change in glaucoma.