After a first glaucoma field progression, four in ten progress again within a decade

Design

Retrospective registry cohort

Population

7,457 eyes of 5,086 patients with open-angle glaucoma or suspected glaucoma; 635 analysed after first progression

Primary outcome

Recurrent visual field progression

Effect

43.5% at 10 years; HR 0.89 per 10% further IOP reduction (0.83–0.94)

This registry cohort at a US tertiary centre followed 7,457 eyes with open-angle glaucoma or suspected glaucoma for a mean of 12 years. Of 635 eyes with adequate follow-up after a first confirmed visual field progression event, 167 (26%) progressed again. Cumulative recurrence was 13.8% at three years and 43.5% at ten.

Recurrence was more likely with faster mean deviation loss before the first event (HR 1.73 per dB/year), higher mean IOP afterwards (HR 1.09 per mmHg), less advanced damage at first progression, and older age. Each further 10% reduction in IOP was associated with a lower hazard (HR 0.89). Eyes that had been losing more than 1 dB a year recurred in 43% against 23% of slower eyes.

The practical reading is that a first progression event should reset both the target pressure and the follow-up interval, with the steepest prior slopes getting the most aggressive response. The study is observational, so the IOP association cannot prove that lowering pressure further prevents recurrence, but it fits everything else known about glaucoma.

• After a confirmed field progression event, set a new, lower target IOP rather than adding a drop and moving on.
• Calculate the pre-event MD slope; eyes losing more than 1 dB a year need the closest follow-up.
• Shorten field-testing intervals after a first progression event, especially in older patients.
• Recheck adherence and drop technique before escalating to laser or surgery.

Why it matters

Intensifying treatment once is often treated as the end of the problem; for many eyes it is not.

Don't overread it

Single-centre and observational; the IOP association is not proof that further lowering prevents recurrence.

The statistics, in plain English

An HR of 0.89 per extra 10% IOP reduction means about 11% lower hazard of further progression for each additional 10% the pressure is lowered. A Kaplan-Meier estimate of 43.5% at 10 years means nearly half the eyes followed that long progressed again.

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