Factors associated with visual field or structure progression occurring first in a prospective study on patients with untreated open-angle glaucoma with normal intraocular pressure

Background/Objectives: To identify factors associated with disc/retina deterioration in stereo fundus photographs preceding that of the visual field (VF), as determined with a Humphrey Field Analyzer (HFA) (Structure First deterioration) and factors associated with the latter preceding the former (Field First deterioration) in open-angle glaucoma (OAG) with lower normal intraocular pressure (IOP).Subjects/Methods: Prospective cohort study. Ninety eyes of 90 patients with OAG and a baseline IOP < 15 mmHg participated in a 5-year prospective study without treatment. IOP measurements and HFA 24-2 Swedish Interactive Test Algorithm Standard tests were performed every 3 months, and fundus photographs were obtained every 6 months. VF deterioration was determined by Guided Progression Analysis and deterioration of disc/retina was determined on stereophotographs by an independent committee. A multivariable Cox proportional hazard model was used to identify factors associated with Structure First deterioration, and with Field First deterioration.Results: The average baseline age and mean deviation were 53.9 +/- 9.8 years and -2.8 +/- 2.8 dB, respectively. During the 5-year follow-up, the probability of Field First deterioration was 49% +/- 6.6% (standard error) and that of Structure First deterioration was 33% +/- 6.4% (P = 0.062, log-rank test). Disc hemorrhage (DH) prior to the event (P = 0.006) was associated with Structure First deterioration, and older age was associated with Field First deterioration (P = 0.040).Conclusions: In OAG eyes with lower normal IOP, DH was significantly associated with Structure First deterioration, and age was significantly associated with Field First deterioration.

Automated summary

This study aimed to identify factors associated with disc/retina deterioration preceding the deterioration of the visual field in patients with OAG. The results showed that disc hemorrhage was significantly associated with disc/retina deterioration preceding visual field deterioration, while age was significantly associated with visual field deterioration preceding disc/retina deterioration.