Risk Factor For Fast Visual Field Progression In Primary Angle Closure Glaucoma

To investigate the baseline and longitudinal risk factors for fast visual field (VF) progression in primary angle closure glaucoma (PACG).

This study was conducted in an eye hospital setting, involving PACG patients who underwent longitudinal visual field (VF) assessments.

VF progression was assessed using the Zeiss Forum software. Progression rates were classified as slow (≥-0.25dB/year), intermediate (-0.25 to -1.0dB/year), and fast (≤-1.0dB/year). The parameters recorded included gender, age at diagnosis of PACG, VF mean deviation, gonioscopy findings, presenting intraocular pressure (IOP), cataract or glaucoma surgery, pre-surgery refractive data, and IOP at all follow-up visits. The following IOP parameters were computed: peak IOP, mean IOP, and IOP fluctuation. Logistic regression analysis was performed to determine the variables associated with fast progression. 

The mean age of PACG diagnosis was 65.6±9.2 years, with 223(46.8%) males. The mean rate of progression was -0.26±0.83 dB/year. Among 477 PACG eyes, 13.6% showed fast progression, 34.4% intermediate and 52.0% slow. Fast progression was common in males(56.9%), older patients (p=0.005), and those with wider gonioscopic angles(p=0.008). They had significantly higher peak IOP(p=0.02), mean IOP(p=0.01), and IOP fluctuation(p=0.003). Slow progressors had the highest presenting IOP(p=0.007) and shortest duration between PACG diagnosis and glaucoma surgery(p<0.001). Multivariate analysis identified older age at diagnosis(<0.05), higher mean IOP(p=0.03) and IOP fluctuation(p=0.004) as predictors of fast progression. 

Fast VF progression occurred in 13.6% of patients despite treatment. Older age at diagnosis, higher mean IOP and IOP fluctuations were associated with fast progression.