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Prediction of Visual Field Progression in Glaucoma

¹From the Glaucoma Division, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California; and the ²University Ophthalmology Consultants of Washington, Washington, DC.

PURPOSE. To determine the probability of future glaucomatous visual field (VF) progression with clinical and perimetric data.

METHODS. One hundred sixty-one eyes of patients (161) enrolled in the Advanced Glaucoma Intervention Study (AGIS) with 8 years of follow-up and a baseline VF score 16 were selected. VF progression at 8 years was determined with point-wise linear regression (PLR) analysis, using a two-omitting algorithm. The course of VF series over the first 4 years of follow-up was quantified by an index, the sum of slopes, which is the sum of all slopes of VF thresholds with P < 0.05 when PLR was performed on the 4-year data. The following parameters were included in a logistic regression model to predict 8-year outcomes from the first 4 years of follow-up: intervention sequence, age, AGIS VF score, mean IOP, IOP fluctuation, and sum of slopes.

RESULTS. Sixty-four (40%) eyes progressed after 8 years as determined by PLR analysis. Two parameters were predictive of subsequent VF progression, as identified at 8 years (predictive power: 76%): more negative sum of slopes (i.e., faster or more extensive deterioration; P < 0.001) and older age at 4 years (P = 0.049). When sum of slopes alone was used to predict outcomes at 8 years, the predictive power was the same.

CONCLUSIONS. The VF sum of slopes can be used to estimate the probability of subsequent VF worsening with reasonable, clinically useful accuracy. This probability may be combined with other clinical information for more effective clinical predictions and treatment decisions.