Comparison of the Progression Rates of the Superior, Inferior, and Both Hemifield Defects in Normal-Tension Glaucoma Patients

PURPOSE: To investigate the progression rates of superior and inferior hemifield defects and each hemifield in bihemifield defects in normal-tension glaucoma patients and to compare the progression rates of each hemifield between groups in eyes with similar baseline hemifield defects. DESIGN: Retrospective, observational cohort study. METHODS: Medical records of 142 normal-tension glaucoma patients who performed more than 5 reliable standard visual field tests with superior (group 2; n = 51), inferior (group 1; n = 44), or both hemifield (group 3; n = 47) defects were analyzed retrospectively. The changes in the mean thresholds of the 10 zones of the glaucoma hemifield test and the entire hemifield were inspected. A linear mixed effect model was used with age, gender, initial intraocular pressure, mean deviation, and pattern standard deviation controlled. RESULTS: There were no significant differences in age and systemic and ocular factors between groups except for female gender, which showed a significant difference among the 3 groups (P = .032). The progression rate in group 2 was significantly faster than in group 1 (-0.713 dB/year vs -0.516 dB/year; P = .019), especially in central and nasal zones or than in the superior hemifield of group 3 (-0.717 dB/year vs -0.470 dB/year; P = .001). There was no significant difference in the progression rates between group 1 and the inferior hemifield in group 3 (-0.508 dB/year vs -0.441 dB/year; P = .312) or between the superior and inferior hemifields in group 3 (-0.468 dB/year vs -0.442 dB/year; P = .662). CONCLUSIONS: More careful examination and caution is required in the treatment of normal-tension glaucoma patients with superior hemifield defect. (Am J Ophthalmol 2012;154:958-968. (C) 2012 by Elsevier Inc. All rights reserved.)