In a presentation slated for tomorrow during the ARVO meeting in Honolulu, Hawaii, researchers will report on rates of global and central visual field changes from glaucoma, and the numbers are worrisome. Nearly a third of all glaucoma patients are expected to experience significant visual impairment in their lifetime, even while receiving care. In a retrospective review of 14,828 eyes of 7,722 patients, the researchers analyzed both mean deviation (MD) and macular total deviation (mTD) at baseline (mean age 66.1±11.3 years) and through their predicted lifetime derived from US Census data. They measured visual field data and defined significant visual impairment as MD ≤-22dB, mTD ≤-15dB and mTD ≤-22dB.

At baseline, 11.5% patients had at least one visually impaired eye with MD ≤-22dB. At the end of the predicted lifetime, that statistic nearly tripled to 29.7%. For those with visual impairment of mTD ≤-15dB, the percentage from baseline to the predicted lifetime end jumped from 22.3% to 43.8%. Lastly, 9.2% showed impairment of mTD ≤-22dB at baseline compared with 29.4% at the predicted end of lifetime. The researchers also noted impairment was more pronounced in the central field, supporting “the importance of monitoring macular damage in glaucoma,” they concluded in the abstract.

“Increased scrutiny in detecting macular damage in glaucoma appears to have significant relevance based on the results of this study assessing visual impairment over time in glaucoma patients,” says Joseph Shovlin, OD, of Scranton, PA. “A more pronounced defect in the central field was expected in the predicted lifetime in a large proportion of patients analyzed. Limitations of a 24-2 field were noted in detecting macular changes; use of 10-2 fields may serve as a better way to evaluate for macular changes associated with glaucoma.”

De Moraes CG, Liebmann JM, Boland MV, et al. Rates of global and central visual field change and visual impairment from glaucoma in the US: The Glaucoma Research Network (GRN). ARVO 2018. Abstract 4465.