Glaucoma Treatments Can Offer Patients Similar Visual Field Findings to Healthy Individuals

The rate of visual field change in patients who begin receiving treatments for their glaucoma early is comparable with that of healthy individuals, according to findings from a prospective longitudinal cohort study published in JAMA Ophthalmology. The investigation had a median follow-up of more than 25 years. 

Estimating the rate of glaucomatous visual field change is critical in the practical assessment of disease progression, in addition to the implications for management decisions, according to the researchers. While a small proportion of patients exhibited faster rates of change — and those patients did have a higher risk for visual impairment — this was not statistically significant. Additionally, findings show that mean follow-up intraocular pressures (IOP) were similar between patients being treated for glaucoma and healthy participants, researchers report.

The study was conducted from January 1991 to February of 2020 in a hospital-based setting and included 40 patients who underwent treatment for open-angle glaucoma, as well as 29 healthy participants. Most participants (94%) were White and had a median age of 53.07 years [IQR, 48.34-57.97 years] among those with glaucoma, and a median age of 48.80 years [IQR, 40.40-59.07 years] among the healthy participants. Both groups received testing with standard automated perimetry every 6 months to estimate the mean rates of sensitivity change, the impact of baseline mean sensitivity, baseline age, and follow-up IOP for rate estimates. 

In an ordinary least-squares regression analysis, 78% of patients with glaucoma had rates of mean sensitivity change within the range of healthy participants (between -0.20 dB/y and 0.15 dB/y). Linear mixed-effects modeling showed a statistically insignificant difference in the mean (SE) rate of sensitivity change in healthy participants of 0.003±0.033 dB/y (95% CI, -0.062 to 0.068; P =.93) as compared with patients with glaucoma who had a mean rate of sensitivity change of -0.032±0.052 dB/y faster. Among covariates, only baseline sensitivity was associated with the rate of mean sensitivity change (mean [SE], 0.021±0.010 dB/y/dB; 95% CI, 0.002-0.041; P =.03). 

The mean follow-up IOP of patients with glaucoma (median, 15.83 mm Hg [IQR, 13.05-17.33 mm Hg]) was similar to that of healthy participants (median, 14.94 mm Hg [IQR, 13.28-16.01 mm Hg]; P =.25). 

Limitations of the research include the team’s method of analyses, which utilized all visual field data, including those derived using the older full-threshold strategy.

“Minimizing the risk of visual impairment among patients with glaucoma relies on making optimal clinical decisions, including the mode and intensity of therapeutic interventions. These decisions frequently depend on an accurate assessment of the rate of visual field change,” the researchers explain. “These findings could guide practitioners in making management decisions.”

Reference

Giammaria S, Hutchison DM, Rafuse PE, et al. Rates of visual field change in patients with glaucoma and healthy individuals. JAMA Ophthalmol. Published online April 7, 2022. doi:10.1001/jamaophthalmol.2022.0671