Central Visual Field Reserve And The Risk Of Visual Acuity Loss After Contemporary Glaucoma Surgery
Published 2026 - 44th Congress of the ESCRS
Reference: POGAU005 | Type: Poster | DOI: 10.82333/bj6r-nq11
Authors: Dr Eran Berkowitz* 1 , Dr Liron Naftali Ben Haim 2 , Dr Idit Solomon-Avizohar 2 , Dr Yelzaveta Chuikova 2 , Dr Polina Isakovich Albagly 1 , Dr Biana Dubinsky-Pertzov 2 , Dr Avner Belkin 2
1Ophthalmology,Hillel Yaffe Medical center,Hadera,Israel, 2Ophthalmology,Meir Hospital,Kfar Saba,Israel
Purpose
To quantify the incidence, causes, and predictors of postoperative visual acuity (VA) loss after contemporary glaucoma surgery in eyes with very advanced, fixation-involving glaucoma, and to determine whether central (10-2) vs peripheral (24-2) visual field metrics better stratify risk.
Setting
Retrospective multicenter cohort study at two tertiary glaucoma centers in Israel (Meir Medical Center, Kfar Saba; Hillel Yaffe Medical Center, Hadera), including surgeries performed 2019–2024.
Methods
Consecutive eyes meeting predefined “very advanced fixation-involving” criteria on 24-2 (MD < –15 dB plus ≥2 fixation points at p≤2%) and/or 10-2 fields (scotomas involving fixation) and ≥6-month follow-up were included. Procedures: trabeculectomy, Ahmed valve, GATT, XEN, PreserFlo, ± cataract extraction. Primary outcome: ≥2 Snellen lines BCVA loss at 6 months; severe loss: ≥2 lines plus VA ≤6/60. Vision loss classified as glaucoma- vs non-glaucoma-related.
Results
174 eyes (mean age 70.1±11.9; 66.1% male) were analyzed. At 6 months, ≥2-line BCVA loss occurred in 27 eyes (15.5%); severe loss occurred in 4 eyes (2.3%). Glaucoma-related VA loss occurred in 8 eyes (4.6%); 5 eyes (2.8%) had VA ≤6/60 and none declined below 1/60. Eyes with VA loss had worse baseline central damage (10-2 MD –22.1±5.2 vs –16.5±7.6 dB; P=0.002), whereas 24-2 MD was not associated. Risk rose non-linearly beyond ~26 dB on 10-2 MD. Combined cataract extraction was associated with lower risk (multivariable OR 0.15; P=0.006).
Conclusions
In eyes with very advanced fixation-involving glaucoma, severe postoperative VA loss is uncommon and is most often not due to glaucomatous progression. Baseline 10-2 mean deviation—reflecting central visual field reserve—predicts postoperative VA loss, while 24-2 MD does not. A practical threshold around 10-2 MD ~–26 dB identifies a non-linear increase in risk and may improve preoperative counselling, procedure planning, and risk-benefit decisions in end-stage disease