Elsevier

Ophthalmology

Volume 111, Issue 9, September 2004, Pages 1627-1635
Ophthalmology

Original article
Predictive factors for glaucomatous visual field progression in the Advanced Glaucoma Intervention Study

Presented at: American Academy of Ophthalmology Annual Meeting, November, 2003; Anaheim, California.
https://doi.org/10.1016/j.ophtha.2004.02.017Get rights and content

Abstract

Purpose

To investigate the risk factors associated with visual field (VF) progression in the Advanced Glaucoma Intervention Study (AGIS) with pointwise linear regression (PLR) analysis of serial VFs.

Design

Prospective, multicenter, randomized clinical trial.

Participants

Five hundred nine eyes of 401 patients from the AGIS with a baseline VF score of ≤16, ≥7 VF examinations, and ≥3 years of follow-up were selected.

Main outcome measure

Visual field progression.

Methods

This is a cohort study of patients enrolled in a prospective randomized clinical trial (AGIS). Worsening of a test location on PLR analysis was defined as a change of threshold sensitivity of ≥1.00 decibels a year, with P≤0.01. Visual field progression was defined as worsening of at least 2 test locations within a Glaucoma Hemifield Test cluster with PLR analysis. Multivariate logistic regression was used to determine risk factors associated with VF worsening. Intraocular pressure (IOP) fluctuation was defined as standard deviation of the IOP at all visits after the initial surgery.

Results

The mean (± standard deviation) follow-up time and baseline AGIS score were 7.4 (±1.7) years and 7.7 (±4.4), respectively. Visual field progression was detected with PLR analysis in 151 eyes (30%). Older age at the initial intervention (P = 0.0012; odds ratio [OR], 1.30; 95% confidence interval [CI], 1.11–1.50), larger IOP fluctuation (P = 0.0013; OR, 1.31; 95% CI, 1.12–1.54), increasing number of glaucoma interventions (P = 0.01; OR, 1.74; 95% CI, 1.14–2.64), and longer follow-up (P = 0.02; OR, 1.19; 95% CI, 1.03–1.38) were associated with increased odds of VF progression. When regression analyses were repeated in eyes with and without a history of cataract extraction, IOP fluctuation was the only variable to be consistently associated with VF progression.

Conclusion

Both increasing age and greater IOP fluctuation increase the odds of VF progression by 30% (for each 5-year increment in age and 1-mmHg increase in IOP fluctuation). The higher risk conferred by IOP fluctuation was consistently observed in eyes with and without a history of cataract extraction.

Section snippets

Materials and methods

The AGIS design and methods are described in detail elsewhere and are summarized here.2, 23 Thirty-five- to 80-year-old phakic patients with open-angle glaucoma no longer controlled by maximally tolerated medical treatment were recruited. Eligible eyes had a best-corrected visual acuity (VA) score of at least 56 letters (Early Treatment Diabetic Retinopathy Study) and met specified criteria for combinations of consistently elevated intraocular pressure (IOP), glaucomatous VF defect, and optic

Results

A total of 151 eyes (29.9%) progressed according to the PLR criteria, whereas 138 eyes (27.1%) showed progression based on AGIS criteria (κ = 0.30, percentage agreement = 64%). The characteristics of the study sample are presented in Table 2 based on occurrence of progression according to PLR criteria. Four eyes were considered indeterminate based on our PLR criteria and were excluded from further analysis. Table 3 describes the results of the multivariate logistic regression. Four variables

Discussion

The baseline characteristics of our subgroup of AGIS patients are similar to those of the original cohort of patients described in previous AGIS reports.2 In this investigation, we used rigorous and clinically relevant PLR criteria to define the main outcome measure, VF worsening. We detected VF progression in approximately 30% of the eyes, which is consistent with the number of eyes showing progression in the same cohort according to the AGIS criteria (27%). We found that greater intervisit

Acknowledgements

The authors thank all the AGIS investigators for their contributions.

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    Manuscript no. 240023.

    Supported by an unrestricted grant from Research to Prevent Blindness, New York, New York, and the National Institutes of Health, Bethesda, Maryland (grant no.: R01 EY12738).

    The authors do not have any commercial or proprietary interest in any of the products or companies cited in the article. Likewise, they have no financial interest in and have not received payment as a consultant, reviewer, or evaluator from any of the companies mentioned.

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