Rate of visual field loss and long-term visual outcome in primary open-angle glaucoma

This study was presented in part at the Association for Research in Vision and Ophthalmology meeting, Fort Lauderdale, Florida, May 2000.
https://doi.org/10.1016/S0002-9394(01)00912-6Get rights and content

Abstract

PURPOSE: To evaluate long-term visual field outcome in primary open-angle glaucoma.

METHODS: In this retrospective cohort study, 40 eyes of 40 patients with primary open-angle glaucoma with elevated intraocular pressure and a minimum of 8-year longitudinal series of visual fields were plotted with Goldmann perimeter. Eyes with any other ocular disease except cataract were excluded. Manual grid templates were used to quantify the visual fields. Linear regression was performed to estimate the rate of visual field decline. Pertinent clinical factors were evaluated for statistical association with the rate of decline. Long-term clinical outcome including visual acuity, rate of legal blindness, and rate of medical and surgical interventions was also measured.

RESULTS: In the 40 eyes studied, with a mean follow-up of 14 years, the visual field score decreased at the rate of −1.5% per year. Overall, 68% showed significant decrease, and the rate of decrease among these eyes was −2.1% per year. Five eyes became legally blind from glaucoma; the cumulative rate of blindness from glaucoma was 19% at 22 years. Higher intraocular pressure and greater number of antiglaucoma medications on initial presentation were associated with faster and slower deterioration of visual field (compared with the average), respectively.

CONCLUSIONS: With standard glaucoma therapy, the rate of visual field loss in primary open-angle glaucoma is slow. Lower intraocular pressure and more antiglaucoma medications are associated with slower visual field decline. Legal blindness from glaucoma is 19% over a follow-up of 22 years.

Section snippets

Methods

In this cohort study, a retrospective chart review was performed on patients with primary open-angle glaucoma who had been followed in the Vascular and Glaucoma Services of the Department of Ophthalmology and Visual Sciences at the University of Iowa since 1972.

The inclusion criteria were as follows: (1) Diagnosis of primary open-angle glaucoma with elevated intraocular pressure as defined by the age of onset 40 years or older, normal-appearing (open) iridocorneal angles, peak intraocular

Results

Forty eyes of 40 patients with primary open-angle glaucoma satisfied our study inclusion and exclusion criteria. Characteristics of patients on initial presentation are shown in Table 1. All patients were Caucasian, reflecting the underlying population demographics of Iowa (98% Caucasian). The average age of patients was 64.3 ± 8.3 years (range, 40 to 84). Eleven eyes had mild cataract on presentation (average cataract score of 1.5) in addition to primary open-angle glaucoma. Coexistent ocular

Discussion

We have presented the long-term clinical outcome (average of 14 years) in a group of primary open-angle glaucoma eyes meeting our inclusion and exclusion criteria. The results indicate the average Goldmann visual field decline is slow, at −1.5% per year for all eyes, and −2.1% per year for the 68% of eyes that showed significant decline. Recently, Rasker and associates6 reported a similar study using an automated perimetry (Peritest, Rodenstock, Munich, Germany) with a mean follow-up of 8

References (17)

There are more references available in the full text version of this article.

Cited by (120)

  • The nitric oxide-guanylate cyclase pathway and glaucoma

    2018, Nitric Oxide - Biology and Chemistry
  • Distribution and Rates of Visual Field Loss across Different Disease Stages in Primary Open-Angle Glaucoma

    2018, Ophthalmology Glaucoma
    Citation Excerpt :

    Because of different vulnerabilities of ganglion cells, the pathophysiology of any patterns of POAG could be different. The rate of VF loss in POAG eyes has been studied by different groups;24–35 however, a comprehensive analysis presenting both patterns and rates of VF loss of POAG eyes using a large cohort with long-term follow-ups has been lacking. We found that the rate of VF loss was faster in eyes at the early stage than in the moderate stage of glaucoma (−0.2 dB/year and −0.12 dB/year, respectively; P = 0.02).

View all citing articles on Scopus

This work was supported in part by the Shaffer International Research Fellowship from the Glaucoma Research Foundation, San Francisco, California, an unrestricted grant from Research to Prevent Blindness, New York, New York, and National Eye Institute research grants EY-1151 and EY-3330. Dr Hayreh is a Research to Prevent Blindness Senior Scientific Investigator.

View full text