Investigation of progression pattern and associated risk factors in glaucoma patients with initial paracentral scotomas using Humphrey 10-2

AbstractCentral visual field (VF) progression could directly threaten patientss visual function compared to glaucomatous damage. This study was designed to investigate visual field (VF) progression pattern and associated risk factors including optical coherence topography angiographic (OCT-A) findings in glaucoma patients with initial paracentral scotoma. This prospective, observational study included 122 eyes presenting as initial paracentral scotomas with serial 24-2 and 10-2 VF tests at the glaucoma clinic of Seoul St Mary's Hospital between November 2017 and August 2020. The participants underwent at least 5 serial VF exams and OCT-A at baseline. Numerical values of the initial and final 10-2 VF tests were averaged for each VF test point using the total deviation map. Innermost 10-2 VF progression was defined as three or more new contiguous points at the central 12 points on 10-2 VF. Other clinical characteristics were collected including history of disc hemorrhage and vessel density (VD) was measured from OCT-A images. Linear regression analysis was performed to obtain the change of mean deviation and a cut-off for progression was defined for both 24-2 and 10-2 VFs. The average total deviation maps of the initial 10-2 VF tests shows initial paracentral scotoma located in the superior region in an arcuate pattern that was deep in the 4°–6° region above fixation. This arcuate pattern was more broadly located in the 4°–10° region in the primary open-angle glaucoma (POAG) group, while it was closer to fixation in 0°–4° region in the normal-tension glaucoma (NTG) group. The final average map shows deepening of scotomas in the 4°–10° region in POAG, which deepened closer to the region of fixation in NTG. The diagnosis of NTG (β 1.892; 95% CI 1.225–2.516; P = 0.035) and lower choroidal VD in the peripapillary atrophy (PPA) region (β 0.985; 95% CI 0.975 to 0.995; P = 0.022) were significantly related to innermost 10-2 VF progression. Initial paracentral scotomas in NTG tended to progress closer to the region of fixation, which should be monitored closely. Important progression risk factors related to paracentral scotoma near the fixation were the diagnosis of NTG and reduced choroidal VD in the β-zone PPA region using OCT-A. We should consider vascular risk factors in NTG patients presenting with initial paracentral scotoma to avoid vision threatening progression of glaucoma.

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Visual Field Damage and Progression in Glaucomatous Myopic Eyes

European Journal of Ophthalmology ◽

10.1177/112067210701700409 ◽

2007 ◽

Vol 17 (4) ◽

pp. 534-537 ◽

Cited By ~ 32

Author(s):

A. Perdicchi ◽

M. Iester ◽

G. Scuderi ◽

S. Amodeo ◽

E.M. Medori ◽

...

Keyword(s):

Visual Field ◽

Open Angle Glaucoma ◽

Linear Regression Analysis ◽

Visual Fields ◽

Light Sensitivity ◽

Progressive Increase ◽

Central Visual Field ◽

Trend Function ◽

Visual Field Damage ◽

Loss Variance

Purpose To make a visual field retrospective analysis on a group of patients with primary open angle glaucoma (POAG) and to evaluate whether different refractive errors could have different progression of the 30° central sensitivity. Methods A total of 110 patients with POAG (52 men and 58 women) were included in the study. All the patients were divided into four subgroups based on the refractive error. The visual field of all the included patients was assessed by an Octopus 30° central visual field every 6 months, for a total of 837 visual fields examined. The resulting data were analyzed by PERIDATA for Windows 1.7 TREND function. Mean defect (MD) and loss variance (LV) were considered for the analysis. Results At the first examination, 82% of eyes showed a global decrease of differential light sensitivity (MD >2 dB) and in 67% the distribution of the defect was nonhomogeneous (LV >6 dB). The analysis of variance for subgroups showed a more significant decrease of MD in highly myopic patients. A linear regression analysis highlighted a statistically significant change in time of MD in 36% and of LV in 34% of the eyes studied. Highly myopic patients had the highest (p<0.01) percentage of change of MD and LV (46% and 42%, respectively). Among the four subgroups, there was no difference in progression of MD decrease in time. Conclusions These results showed that after 5 years of glaucoma, the visual field was altered in most of the eyes examined (82%) and that in 67% of cases, its defect was nonhomogeneous and worsened with the increase of myopia. The regression linear analysis of visual field changes in time showed a progressive increase of MD and LV in approximately one third of all the eyes examined.

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Central macular OCTA parameters in glaucoma

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2021-319574 ◽

2021 ◽

pp. bjophthalmol-2021-319574

Author(s):

Takashi Nishida ◽

Won Hyuk Oh ◽

Sasan Moghimi ◽

Adeleh Yarmohammadi ◽

Huiyuan Hou ◽

...

Keyword(s):

Visual Field ◽

Mixed Model ◽

Linear Mixed Model ◽

Open Angle Glaucoma ◽

Foveal Avascular Zone ◽

Mean Deviation ◽

Automated Perimetry ◽

Central Visual Field ◽

Foveal Thickness ◽

Glaucoma Suspect

Background/aimsTo investigate the relationship between the foveal avascular zone (FAZ) parameters assessed by optical coherence tomography angiography (OCTA) and central visual field parameters in glaucoma and healthy subjects.MethodsOne hundred and eighty-eight subjects (248 eyes), including 24 healthy (38 eyes), 37 glaucoma suspect (42 eyes, and 127 primary open angle glaucoma (POAG) patients (168 eyes), underwent imaging using OCTA and standard automated perimetry using the 24-2 and 10-2 Swedish Interactive Thresholding Algorithm. OCTA-based and OCT-based FAZ parameters (superficial FAZ area, FAZ circumference), foveal vessel density (FD300) and foveal thickness were measured. The correlation between FAZ parameters and visual field parameters was assessed using linear mixed model.ResultsAxial length adjusted-FAZ area was not different among the three groups (mean (95% CI)): in healthy 0.31 (0.27 to 0.36) mm2, glaucoma suspect 0.29 (0.26 to 0.31) mm2 and POAG eyes 0.28 (0.27 to 0.30) mm2 (p=0.578). FD300 was lower in glaucoma suspect 49.1% (47.9% to 50.4%) and POAG eyes 48.7% (48.1% to 49.4%) than healthy eyes 50.5% (49.3% to 51.7%) though the difference was not statistically significant (p=0.071). Lower FD300 was associated with worse 24-2 and 10-2 visual field mean deviation and foveal threshold in multivariable linear mixed models (all p<0.05). In addition, a smaller FAZ area was associated with lower intraocular pressure (IOP) (p=0.026).ConclusionsThe FD300, but not the FAZ area was correlated with 10° central visual field mean deviation and foveal threshold in healthy, glaucoma suspect and POAG eyes. In contrast, a smaller FAZ area was associated with lower IOP.

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Influence of initial visual field sensitivity on visual field loss progression in open angle glaucoma

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1204142h ◽

2012 ◽

Vol 140 (3-4) ◽

pp. 142-147

Author(s):

Paraskeva Hentova-Sencanic ◽

Marija Bozic ◽

Ivan Sencanic ◽

Milos Jovanovic ◽

Branislav Stankovic ◽

...

Keyword(s):

Visual Field ◽

Open Angle Glaucoma ◽

Linear Regression Analysis ◽

Regression Line ◽

Rate Of Change ◽

Open Angle ◽

Central Visual Field ◽

Study Results ◽

The Mean ◽

Mean Sensitivity

Introduction. It is important to know the risk factors for visual field defect progression in order to predict the future development of glaucoma. Objective. To investigate the influence of visual field initial sensitivity on the rate of visual field progression. Methods. A minimum of five visual fields were performed using computerized perimetry (Octopus) over a mean follow- up 4-year period (48.85?17.84 months) in 64 persons (114 eyes) with primary open angle glaucoma. The rate of change of the whole central visual field and each of the seven regions of the field were measured by linear regression analysis of the mean sensitivity value versus time. Based on the slope of the regression line of visual field mean sensitivity over time the eyes were divided into two groups: the group with stable and the group with progressive visual field. The comparison of the mean sensitivity of the whole central visual field between the groups was performed using the Mann-Whitney U-test. The Spearman rang correlation coefficient and the Spearman probability p values were calculated to assess the mean sensitivity of the whole central visual field and of each visual field regions determined at the beginning of the study. Results. The initial mean sensitivity of the whole central visual field was lower in the group with progressive visual field (16.62?6.35 dB). Correlation between the initial mean sensitivity and the slope of the regression line was negative. The lowest mean sensitivity was in the group with progressive visual field in the upper temporal (13.73?7.35 dB), nasal (14.74?7.23 dB) and upper nasal (15.03?7.75 dB) regions. Conclusion. The lower mean sensitivity value of the visual field, especially in the nasal and upper nasal visual field regions, carries a greater risk for delayed progressive loss of the visual field in persons with glaucoma.

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Changes in Peripapillary and Macular Vessel Densities and Their Relationship with Visual Field Progression after Trabeculectomy

Journal of Clinical Medicine ◽

10.3390/jcm10245862 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5862

Author(s):

Jooyoung Yoon ◽

Kyung Rim Sung ◽

Joong Won Shin

Keyword(s):

Visual Field ◽

Linear Regression ◽

Open Angle Glaucoma ◽

Linear Regression Analysis ◽

Reduction Rate ◽

Vessel Density ◽

Mean Deviation ◽

Factors Associated ◽

Significant Difference

The aim of this study was to determine the factors associated with visual field (VF) deterioration after trabeculectomy, including the peripapillary vessel density (pVD) and macular vessel density (mVD) changes assessed by optical coherence tomography angiography (OCT-A). Primary open-angle glaucoma patients with more than two years of follow-up after trabeculectomy were included. pVD was calculated in a region defined as a 750 μm-wide elliptical annulus extending from the optic disc boundary. mVD was calculated in the parafoveal (1–3 mm) and perifoveal (3–6 mm) regions. VF deterioration was defined as the rate of mean deviation (MD) worse than −1.5 dB/year. The change rates of pVD and mVD were compared between the deteriorated VF and non-deteriorated VF groups. The factors associated with the rate of MD were determined by linear regression analyses. VF deterioration was noted in 14 (21.5%) of the 65 eyes that underwent trabeculectomy. The pVD (−2.26 ± 2.67 vs. −0.02 ± 1.74%/year, p ≤ 0.001) reduction rate was significantly greater in the deteriorated VF group than in the non-deteriorated VF group, while that of parafoveal (p = 0.267) and perifoveal (p = 0.350) VD did not show a significant difference. The linear regression analysis showed that the postoperative MD reduction rate was significantly associated with the rate of pVD reduction (p = 0.016), while other clinical parameters and preoperative vascular parameters did not show any association. Eyes with greater loss of peripapillary retinal circulation after trabeculectomy tended to exhibit VF deterioration. The assessment of peripapillary vascular status can be an adjunctive strategy to predict visual function after trabeculectomy.

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Systemic and Ocular Hemodynamic Risk Factors in Glaucoma

BioMed Research International ◽

10.1155/2015/141905 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 26

Author(s):

Jaewan Choi ◽

Michael S. Kook

Keyword(s):

Risk Factors ◽

Visual Field ◽

Open Angle Glaucoma ◽

Ischemia Reperfusion ◽

Visual Field Loss ◽

Normal Tension Glaucoma ◽

Ocular Blood Flow ◽

Systemic Hypertension ◽

Central Visual Field ◽

Tissue Ischemia

Primary open angle glaucoma (POAG) is a multifactorial disease characterized by progressive retinal ganglion cell death and visual field loss. It is known that alterations in intraocular pressure (IOP), blood pressure (BP), and ocular perfusion pressure (OPP) can play a significant role in the pathogenesis of the disease. Impaired autoregulatory capacity of ocular blood vessels may render tissues vulnerable to OPP changes and potentially harmful tissue ischemia-reperfusion damage. Vascular risk factors should be considered more important in a subgroup of patients with POAG, and especially in patients with normal tension glaucoma (NTG) with evidence of unphysiological BP response. For example, reduction of BP during the nighttime has an influence on OPP, and increased circadian OPP fluctuation, which might stand for unstable ocular blood flow, has been found to be the consistent risk factor for NTG development and progression. Central visual field may be affected more severely than peripheral visual field in NTG patients with higher 24-hour fluctuation of OPP. This review will discuss the current understanding of allegedly major systemic and ocular hemodynamic risk factors for glaucoma including systemic hypertension, arterial stiffness, antihypertensive medication, exaggerated nocturnal hypotension, OPP, and autonomic dysregulation.

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Glaucoma Progression after Delivery in Patients with Open-Angle Glaucoma Who Discontinued Glaucoma Medication during Pregnancy

Journal of Clinical Medicine ◽

10.3390/jcm10102190 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2190

Author(s):

Duri Seo ◽

Taekjune Lee ◽

Joo Yeon Kim ◽

Gong Je Seong ◽

Wungrak Choi ◽

...

Keyword(s):

Visual Field ◽

Open Angle Glaucoma ◽

Linear Regression Analysis ◽

Univariate Analysis ◽

Field Tests ◽

Mean Deviation ◽

Close Monitoring ◽

Open Angle ◽

Fiber Layer ◽

Glaucoma Progression

In this retrospective study, clinical characteristics and glaucoma progression of open-angle glaucoma (OAG) patients who discontinued intraocular pressure (IOP)-lowering medication during pregnancy were investigated. Glaucoma progression was determined using either serial visual field tests or optic disc/retinal nerve fiber layer (RNFL) photographs. Age, number of previous pregnancies, diagnosis, average IOP, IOP fluctuation, visual field mean deviation, pattern standard deviation, and RNFL thickness were examined, and their association with glaucoma progression was determined using linear regression analysis. Among 67 eyes (37 patients), 19 eyes (28.4%) exhibited glaucoma progression 13.95 ± 2.42 months after delivery. The progression group showed significantly higher mean IOP than the nonprogression group in the first, second, and third trimesters (p = 0.02, 0.001, and 0.04, respectively). The average IOP in the second, and third trimesters and IOP fluctuation during the entire pregnancy were significantly associated with glaucoma progression according to a univariate analysis (p = 0.04, 0.031, and 0.026, respectively). In conclusion, IOP elevation during pregnancy is associated with glaucoma progression after delivery in patients who had discontinued medication during pregnancy. Therefore, close monitoring of glaucoma is necessary, particularly if patients discontinue medication during pregnancy, and appropriate intervention should be considered in case of increased IOP.

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Comparing the usefulness of a new algorithm to measure visual field using the variational Bayes linear regression in glaucoma patients, in comparison to the Swedish interactive thresholding algorithm

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-318304 ◽

2021 ◽

pp. bjophthalmol-2020-318304

Author(s):

Hiroshi Murata ◽

Ryo Asaoka ◽

Yuri Fujino ◽

Masato Matsuura ◽

Kazunori Hirasawa ◽

...

Keyword(s):

Visual Field ◽

Linear Regression ◽

Open Angle Glaucoma ◽

Variational Bayes ◽

Mean Deviation ◽

Test Duration ◽

Field Analyser ◽

Measurement Duration ◽

Measurement Algorithm ◽

Thresholding Algorithm

Background/aimsWe previously reported that the visual field (VF) prediction model using the variational Bayes linear regression (VBLR) is useful for accurately predicting VF progression in glaucoma (Invest Ophthalmol Vis Sci. 2014, 2018). We constructed a VF measurement algorithm using VBLR, and the purpose of this study was to investigate its usefulness.Method122 eyes of 73 patients with open-angle glaucoma were included in the current study. VF measurement was performed using the currently proposed VBLR programme with AP-7700 perimetry (KOWA). VF measurements were also conducted using the Swedish interactive thresholding algorithm (SITA) standard programme with Humphrey field analyser. VF measurements were performed using the 24–2 test grid. Visual sensitivities, test–retest reproducibility and measurement duration were compared between the two algorithms.ResultMean mean deviation (MD) values with SITA standard were −7.9 and −8.7 dB (first and second measurements), whereas those with VBLR-VF were −8.2 and −8.0 dB, respectively. There were no significant differences across these values. The correlation coefficient of MD values between the 2 algorithms was 0.97 or 0.98. Test–retest reproducibility did not differ between the two algorithms. Mean measurement duration with SITA standard was 6 min and 02 s or 6 min and 00 s (first or second measurement), whereas a significantly shorter duration was associated with VBLR-VF (5 min and 23 s or 5 min and 30 s).ConclusionVBLR-VF reduced test duration while maintaining the same accuracy as the SITA-standard.

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Comparison of Latanoprost/Timolol with Carbonic Anhydrase Inhibitor and Dorzolamide/Timolol with Prostaglandin Analog in the Treatment of Glaucoma

Journal of Ophthalmology ◽

10.1155/2014/975429 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Kenji Inoue ◽

Shoichi Soeda ◽

Goji Tomita

Keyword(s):

Visual Field ◽

Fixed Combination ◽

Open Angle Glaucoma ◽

Field Testing ◽

Mean Deviation ◽

Single Action ◽

Before And After ◽

Group 2 ◽

Concomitant Medications ◽

Medication Changes

Purpose.We retrospectively reviewed medical records of glaucoma patients to investigate how switching medications may affect intraocular pressure (IOP) management. Three concomitant medications were changed to two medications: one combination drop and one single-action drop. Associated adverse effects were also examined.Subjects and Methods.A total of 112 patients with primary open-angle glaucoma or ocular hypertension were examined. All patients were concomitantly using a prostaglandin (PG) analog, aβ-blocker, and a carbonic anhydrate inhibitor (CAI). Fifty-five patients began using latanoprost (PG analog)/timolol (β-blocker) fixed-combination (LTFC) drops and a CAI (group 1), and 57 patients began using dorzolamide (CAI)/timolol fixed-combination (DTFC) drops and a PG analog (group 2). The IOP was measured every 6 months for 2 years following medication changes. Changes in visual field mean deviation (MD) and medication discontinuations were also examined.Results.There were no significant differences in IOP or MD values before and after medication changes in either group. The proportion of medication discontinuations, uncontrolled IOP, and adverse reactions was similar in both groups.Conclusion.Switching patients from multiple single-action medications to combination medications was not associated with changes in IOP, visual field testing results, or adverse event frequency.

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Role of Central Corneal Thickness on Baseline Parameters and Progression of Visual Fields in Open Angle Glaucoma

European Journal of Ophthalmology ◽

10.1177/112067210701700411 ◽

2007 ◽

Vol 17 (4) ◽

pp. 545-549 ◽

Cited By ~ 14

Author(s):

H. Shah ◽

C. Kniestedt ◽

A. Bostrom ◽

R. Stamper ◽

S. Lin

Keyword(s):

Visual Field ◽

Central Corneal Thickness ◽

Open Angle Glaucoma ◽

Corneal Thickness ◽

Visual Fields ◽

Negative Relationship ◽

Significant Risk ◽

Mean Deviation ◽

Open Angle ◽

Visual Field Progression

Purpose To evaluate the relationship of central corneal thickness (CCT) to baseline visual field parameters and visual field progression in patients with primary open-angle glaucoma (POAG). Methods Charts of consecutive patients with POAG were reviewed to obtain visual field data. Visual field was measured by standard threshold static perimetry. Variables analyzed included mean deviation (MD) and pattern standard deviation (PSD). Results A total of 121 eyes examined over 4 years were evaluated. A significant negative relationship between CCT and PSD (correlation coefficient: −0.02, p<0.05) was found. Analyses comparing CCT to change in PSD and MD (visual field progression) were statistically not significant. Conclusions Patients with thinner corneas initially present with a greater visual field defect, indicating that thin corneas may contribute to advanced glaucomatous damage at the time of diagnosis. However, CCT does not seem to be a significant risk factor for progression of the disease.

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Classification and Statistical Trend Analysis in Detecting Glaucomatous Visual Field Progression

Journal of Ophthalmology ◽

10.1155/2019/1583260 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Cristiana Valente ◽

Elisa D’Alessandro ◽

Michele Iester

Keyword(s):

Statistical Analysis ◽

Standard Deviation ◽

Visual Field ◽

Trend Analysis ◽

Open Angle Glaucoma ◽

Mean Deviation ◽

Threshold Strategy ◽

Visual Field Progression ◽

The Mean

Aim. To evaluate the agreement between different methods in detection of glaucomatous visual field progression using two classification-based methods and four statistical approaches based on trend analysis. Methods. This is a retrospective and longitudinal study. Twenty Caucasian patients (mean age 73.8 ± 13.43 years) with open-angle glaucoma were recruited in the study. Each visual field was assessed by Humphrey Field Analyzer, program SITA standard 30-2 or 24-2 (Carl Zeiss Meditec, Inc., Dublin, CA). Full threshold strategy was also accepted for baseline tests. Progression was analyzed by using Hodapp–Parrish–Anderson classification and the Advanced Glaucoma Intervention Study visual field defect score. For the statistical analysis, linear regression (r2) was calculated for mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI), and when it was significant, each series of visual field was considered progressive. We also used Progressor to look for a significant progression of each visual field series. The agreement between methods, based on statistical analysis and classification, was evaluated using a weighted kappa statistic. Results. Thirty-eight visual field series were analyzed. The mean follow-up time was 6.2 ± 1.53 years (mean ± standard deviation). At baseline, the mean MD was −7.34 ± 7.18 dB; at the end of the follow-up, the mean MD was −9.25 ± 8.65 dB; this difference was statistically significant (p<0.001). The agreement to detect progression was fair between all methods based on statistical analysis and classification except for PSD r2. A substantial agreement (κ = 0.698 ± 0.126) was found between MD r2 and VFI r2. With the use of all the statistical analysis, there was a better time-saving. Conclusions. The best agreement to detect progression was found between MD r2 and VFI r2. VFI r2 showed the best agreement with all the other methods. GPA2 can help ophthalmologists to detect glaucoma progression and to help in treatment decisions. PSD r2 was the worse method to detect progression.

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