A study at the Jules Stein Eye Institute at the University of California Los Angeles has found that the presence of an acquired pit of the optic nerve is associated with more rapid visual field (VF) worsening in eyes with primary open-angle glaucoma (POAG). These patients have a greater vulnerability for focal optic nerve defects associated with deeper localized scotomata.

The study compared consecutive POAG patients with an acquired optic nerve pit, POAG controls matched for age, gender, baseline intraocular pressure and baseline mean deviation (MD). The researchers used pointwise rate of change comparisons between the two groups, as well as the MD rate, visual field index (VFI) rate and glaucoma rate index global rate comparisons.

The researchers noted that the mean rate of change was faster in the optic nerve pit group (−1.00%/year) compared with the control group (−0.25%/year). Patients with POAG and a optic nerve pit exhibited a significantly faster decay rate measured with all methods compared with the control group: MD rate difference, −0.25dB/year vs. 0.03dB/year; VFI rate difference, −0.76%/year vs. −0.05%/year; glaucoma rate index rate difference, −8.52 vs. -3.75.

The research team believes identifying the likelihood of fast progression can help clinicians consider suitably aggressive, individualized treatment for this POAG phenotype.

Mahmoudinezhad G, Lin M, Rabiolo A, et al. Rate of visual field decay in glaucomatous eyes with acquired pits of the optic nerve. Br J Ophthalmol. May 13, 2020. [Epub ahead of print].