A team of researchers from the Jules Stein Eye Institute and UCLA report certain factors—including Asian descent and previous cataract surgery—can cause visual field (VF) fluctuations. Additionally, they were able to link nearly 60% of the VF long-term fluctuations through a multivariable model used in the study.

The investigation, published in Ophthalmology, included 1,392 eyes of 816 patients who had six or more VF tests and were followed for at least three years.

For each eye, the researchers evaluated the trends in VF changes over time, and determined the average variability.

The study tested several baseline variables as potential predictors for VF fluctuation, including age, gender, eye laterality, ethnicity, intraocular pressure (IOP), central corneal thickness, number of glaucoma medications, spherical equivalent, best-corrected visual acuity, lens status, previous glaucoma surgery, mean deviation, hypertension, diabetes, smoking and family history of glaucoma. The investigators also tested longitudinal variables including IOP fluctuation, length of follow-up, frequency of VFs, glaucoma/cataract surgery, rate of VF decay, false positives and false negatives and fixation loss rates.

In the global model, the study found several predictors of VF fluctuation, including a predominance in the left eye, Asian descent, larger IOP fluctuation, intervening cataract surgery, longer follow-up, worse baseline mean deviation, faster VF decay rates and higher false positive and false negative rates.

In the pointwise model, the study reported increased VF fluctuation predictors included larger IOP fluctuations, longer follow-up, higher VF frequency, intervening glaucoma surgery, worse baseline mean deviation, faster VF decay rates and higher false positive and higher false negative rates.           

The multivariable model linked 57% and 28% of the pointwise and global variances, respectively, the study noted.

 “In the presence of factors predictive of high fluctuation, increased frequency of testing and better analytics will help identify VF progression more accurately,” the researchers wrote in their paper. 

Rabiolo A, Morales E, Kim JH, et al. Predictors of long-term visual field fluctuation in glaucoma patients. Ophthalmol. December 5, 2019. [Epub ahead of print].