IOP levels that fluctuate frequently may indicate that a patient is at increased risk for visual field decline. Photo: Natalie A. Townsend, OD.

With a need for additional research on advanced glaucoma, researchers recently initiated a study to identify the risk factors associated with visual field progression among patients with advanced primary open-angle glaucoma (POAG). Their data revealed that long-term IOP fluctuations and disc hemorrhage increase the risk of visual field progression among these patients, even at low pressures.

Through a retrospective review of medical records, the researchers identified 122 patients with POAG who had undergone IOP measurement, standard automated perimetry, cirrus OCT and fundus photography at six-month intervals. The study authors defined visual field progression as deterioration of a minimum of three visual field locations more than baseline at 5% levels in four consecutive visual fields with 24-2 SITA testing.

The data revealed that 29.5% of eyes had visual field progression during the follow-up period (100.7±44.2 months). The researchers reported that patients with progression showed greater long-term IOP fluctuations compared with those with no progression. Additionally, the proportion of patients with disc hemorrhage was significantly higher among those with progression vs. the non-progression group (40.5% vs. 17.4%).

Findings from the multivariate Cox regression analysis showed that long-term IOP fluctuations and disc hemorrhage are independent risk factors of visual field progression, according to the study authors, who also observed that patients with both disc hemorrhage and long-term IOP fluctuations had the greater risk.

“The present study confirmed disc hemorrhage and long-term IOP fluctuations as independent and additive risk factors of visual field progression in the advanced stage of POAG, just as they are in earlier stages of the disease,” the study authors concluded. “Patients with advanced nerve damage and field loss, especially those in whom these factors are recognized, need vigorous treatment and close monitoring.”

Lee JS, Park S, Seong GJ, et al. Long-term intraocular pressure fluctuation is a risk factor for visual field progression in advanced glaucoma. J Glaucoma. March 11, 2022. [Epub ahead of print].