Adelpour Mohsen, Moghimi Sasan, Nishida Takashi, Meller Leo, Du Kelvin H, Kamalipour Alireza, Tansuebchueasai Natchada, Mahmoudinezhad Golnoush, Zangwill Linda M, Weinreb Robert N
Viterbi Family Department of Ophthalmology, Shiley Eye Institute, Hamilton Glaucoma Center, University of California San Diego, La Jolla, California.
Viterbi Family Department of Ophthalmology, Shiley Eye Institute, Hamilton Glaucoma Center, University of California San Diego, La Jolla, California; Faculty of Medicine, Department of Ophthalmology, Prince of Songkla University, Songkhla, Thailand.
Ophthalmol Glaucoma. 2025 Jun 3. doi: 10.1016/j.ogla.2025.05.006.
To explore the prognostic significance of short-term rates of visual field (VF) mean deviation (MD) change in predicting progression across various levels of glaucoma severity.
Observational cohort.
A total of 349 eyes from 254 patients followed up to 5 years.
Primary open-angle glaucoma eyes were included with ≥ 5 24-2 VFs tests during the initial 2 years over a period of up to 5 years. Two assessment methods, Guided Progression Analysis (GPA) and a United States Food and Drug Administration (FDA)-consistent end point, were utilized to identify progression events. Rates of change in VF MD during the initial 2 years were calculated, and survival models were employed to evaluate the risk of faster initial VF MD loss on the development of GPA and FDA-consistent end points.
Risk of progression based on initial MD change rates.
Over a mean follow-up of 4.3 years, progression was observed in 17.2% (GPA end point) and 24.9% (FDA-consistent end point) of eyes. Faster initial rates of VF MD loss significantly increased the progression risk (hazard ratio [HR] per 0.1 dB/year faster for GPA: 1.16, 95% confidence interval [CI]: 1.12-1.20; HR for FDA: 1.16, 95% confidence interval: 1.12-1.21; both P < 0.001) with survival-adjusted R values of 0.67 for GPA and 0.75 for FDA-consistent end points. Global initial 2-year slopes showed the highest predictive accuracy for FDA progression events, with adjusted R values of 0.75 overall, 0.71 for early glaucoma, and 0.42 for moderate-to-advanced glaucoma. Superior and inferior sectoral slopes demonstrated lower abilities to explain the variability across all severity groups. The model's predictive accuracy was higher in early glaucoma (R, 0.71) compared to moderate-advanced stages (R, 0.42) for both criteria.
The initial 2-year rate of VF MD change predicts subsequent progression events based on FDA-consistent criteria in both early and moderate-to-advanced glaucoma eyes. These findings suggest initial VF MD change rates identify patients at higher risk of future progression, enabling timely management decisions and, also, potentially serving as a progression end point in clinical trials.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
探讨视野（VF）平均偏差（MD）变化的短期速率在预测不同严重程度青光眼进展中的预后意义。
观察性队列研究。
共纳入254例患者的349只眼，随访5年。
纳入原发性开角型青光眼患者，在最初2年期间进行了≥5次24-2视野检查，随访时间最长5年。采用两种评估方法，即引导进展分析（GPA）和美国食品药品监督管理局（FDA）一致的终点，来确定进展事件。计算最初2年期间VF MD的变化率，并采用生存模型评估VF MD早期更快丧失对GPA和FDA一致终点发生的风险。
基于初始MD变化率的进展风险。
平均随访4.3年，17.2%（GPA终点）和24.9%（FDA一致终点）的眼出现进展。VF MD早期更快的丧失率显著增加了进展风险（GPA每快0.1 dB/年的风险比[HR]：1.16，95%置信区间[CI]：1.12 - 1.20；FDA的HR：1.16，95%置信区间：1.12 - 1.21；P均<0.001），GPA的生存调整后R值为0.67，FDA一致终点为0.75。最初2年的总体斜率对FDA进展事件显示出最高的预测准确性，总体调整后R值为0.75，早期青光眼为0.71，中度至重度青光眼为0.42。上半和下半象限斜率在解释所有严重程度组的变异性方面能力较低。两种标准下，该模型在早期青光眼（R，0.71）中的预测准确性均高于中度至重度阶段（R，0.42）。
VF MD变化的最初2年利率可根据FDA一致标准预测早期和中度至重度青光眼患者后续的进展事件。这些发现表明，VF MD的初始变化率可识别未来进展风险较高的患者，有助于及时做出管理决策，并且有可能在临床试验中作为进展终点。
在本文末尾的脚注和披露中可能会发现专有或商业披露信息。
