After a first visual field progression in glaucoma, recurrence is common

Design

Retrospective single-centre registry cohort

Population

635 glaucomatous eyes with a first visual field progression event and adequate follow-up

Primary outcome

Recurrent visual field progression

Effect

Cumulative recurrence 43.5% at 10 years; per 10% IOP reduction HR 0.89 (95% CI 0.83 to 0.94)

A US single-centre registry followed 7,457 eyes of 5,086 patients with open-angle glaucoma or suspected glaucoma for a mean of 12 years. Of 1,951 eyes with a first confirmed likely-progression event on guided progression analysis, 635 had enough follow-up and pressure data to study recurrence.

Recurrence occurred in 26% overall: 13.8% by three years and 43.5% by ten. Faster visual field loss before the first event (HR 1.73 per dB per year), higher mean intraocular pressure afterwards (HR 1.09 per mmHg), older age, and less advanced damage at the first event were associated with recurrence. Each additional 10% reduction in pressure after the event was associated with lower risk (HR 0.89, 95% CI 0.83 to 0.94). Eyes losing more than 1 dB a year before the event recurred in 43% versus 23% of slower eyes.

The practical message is that a first progression event is not a one-off to be fixed with one treatment step. The pre-event rate of loss identifies who needs closer watching, and pressure reduction after the event still matters.

This is observational, from one centre, and most eyes lacked follow-up data, so the exact rates may not generalise.

• Calculate the rate of mean deviation loss before a progression event; faster loss predicts recurrence.
• After a first progression event, aim for a meaningful further pressure reduction.
• Consider shorter field-testing intervals for eyes that were losing more than 1 dB a year.
• Older patients carried higher recurrence risk in this cohort.
• Recheck pressure after any treatment change to confirm the target is met.

Why it matters

A first progression event marks an eye at continuing risk, not a problem solved.

Don't overread it

This is an association from one centre; it does not prove that extra pressure lowering prevents recurrence.

The statistics, in plain English

An HR of 0.89 per 10% greater pressure reduction means roughly 11% lower risk of recurrence for each extra 10% drop, as an association. Kaplan-Meier estimates at ten years rest on fewer eyes and are less precise.

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