Short-Term Rates of Visual Field Change Predict Glaucoma Progression.

Purpose: To explore the prognostic significance of short-term rates of visual field (VF) mean deviation (MD) change in predicting progression across various levels of glaucoma severity.

Design: Observational cohort.

Participants: A total of 349 eyes from 254 patients followed up to 5 years.

Methods: Primary open-angle glaucoma eyes were included with ≥ 5 24-2 VFs tests during the initial 2 years over a period of up to 5 years. Two assessment methods, Guided Progression Analysis (GPA) and a United States Food and Drug Administration (FDA)-consistent end point, were utilized to identify progression events. Rates of change in VF MD during the initial 2 years were calculated, and survival models were employed to evaluate the risk of faster initial VF MD loss on the development of GPA and FDA-consistent end points.

Main Outcomes And Measures: Risk of progression based on initial MD change rates.

Results: Over a mean follow-up of 4.3 years, progression was observed in 17.2% (GPA end point) and 24.9% (FDA-consistent end point) of eyes. Faster initial rates of VF MD loss significantly increased the progression risk (hazard ratio [HR] per 0.1 dB/year faster for GPA: 1.16, 95% confidence interval [CI]: 1.12-1.20; HR for FDA: 1.16, 95% confidence interval: 1.12-1.21; both P < 0.001) with survival-adjusted R values of 0.67 for GPA and 0.75 for FDA-consistent end points. Global initial 2-year slopes showed the highest predictive accuracy for FDA progression events, with adjusted R values of 0.75 overall, 0.71 for early glaucoma, and 0.42 for moderate-to-advanced glaucoma. Superior and inferior sectoral slopes demonstrated lower abilities to explain the variability across all severity groups. The model's predictive accuracy was higher in early glaucoma (R, 0.71) compared to moderate-advanced stages (R, 0.42) for both criteria.

Conclusions: The initial 2-year rate of VF MD change predicts subsequent progression events based on FDA-consistent criteria in both early and moderate-to-advanced glaucoma eyes. These findings suggest initial VF MD change rates identify patients at higher risk of future progression, enabling timely management decisions and, also, potentially serving as a progression end point in clinical trials.

Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.