Glaucoma with central field defects: inferior or two-hemifield involvement predicted progression

Design

Retrospective multicentre longitudinal cohort, Japan

Population

127 eyes of 94 adults with glaucoma, baseline central field defects and at least 10 years of 10-2 follow-up

Primary outcome

Time to central visual field progression by baseline defect distribution

Effect

Inferior defects HR 3.27 (95% CI 2.67 to 3.99); both-hemifield defects HR 3.71 (3.02 to 4.57)

A retrospective multicentre cohort at three Japanese centres studied 127 eyes of 94 adults with glaucoma, baseline central visual field defects, baseline 24-2 mean deviation better than -6 dB and at least ten years of 10-2 field follow-up. Progression was defined with clustered pointwise linear regression.

Over a mean of 12.7 years, 53 eyes (41.7%) progressed. Inferior defects and defects in both hemifields were commoner in progressing eyes (54.7% versus 16.2% and 41.5% versus 4.1%). After adjusting for age, mean intraocular pressure and baseline 10-2 mean deviation, inferior defects (hazard ratio 3.27, 95% CI 2.67 to 3.99) and both-hemifield defects (3.71, 3.02 to 4.57) were associated with progression. Particular archetypal patterns were also linked.

The cohort is small, retrospective and selected for long follow-up, and the narrow confidence intervals reflect clustering of eyes rather than certainty. Baseline 10-2 distribution may help decide which eyes need closer central field surveillance.

• 41.7% of eyes progressed over about 12.7 years.
• Inferior defects carried a hazard ratio of 3.27 for progression.
• Defects in both hemifields carried a hazard ratio of 3.71.
• Adjustment included age, pressure and baseline 10-2 mean deviation.
• Consider 10-2 testing in eyes with early glaucoma and central defects.

Why it matters

Central field loss threatens reading and driving, and the 24-2 test can miss it.

Don't overread it

A retrospective cohort selected for long follow-up shows association and may not generalise to all glaucoma patients.

The statistics, in plain English

A hazard ratio of about 3.3 means that at any time eyes with an inferior central defect progressed at roughly three times the rate. Both eyes of one patient were included, so the narrow intervals overstate precision.

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