Lee Lok Hin, Xie Yangyiran, Bradley Chris, Yohannan Jithin
Vanderbilt School of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America.
Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
medRxiv. 2025 Jun 20:2025.05.18.25327880. doi: 10.1101/2025.05.18.25327880.
To evaluate clinical and sociodemographic factors associated with selecting treatments in glaucoma patients with rapid visual field (VF) progression.
Retrospective cohort study.
2,782 eyes from 1,812 adults with 5 or more 24-2 visual fields over five years and at least one optical coherence tomography (OCT) scan.
Rapid progressors were defined by mean deviation (MD) slopes worse than -1 dB/year. Demographic (age, gender, race), clinical (intraocular pressure (IOP), VF metrics, OCT measures), and socioeconomic (social vulnerability index, or SVI) variables were collected. Patients were categorized based on the most intensive treatment received in the first seven years: medical management, minimally invasive procedures (e.g., minimally invasive glaucoma surgery or laser), or aggressive procedures (e.g., filtering surgery or external ciliodestruction). Logistic regression was performed to identify demographic, clinical, and socioeconomic factors associated with treatment intensity.
Odds of treatment selection based on rapid VF progression.
Rapid progressors had significantly higher odds of receiving aggressive procedures (odds ratio [OR] 3.83, 95% confidence interval [CI] 2.56-5.74, p < 0.001) and any procedure (OR 3.15, 95% CI 2.28-4.35, p < 0.001), yet only 23% of rapid progressors underwent aggressive procedures in the first seven years. Among rapid progressors, worse MD and smaller rim area predicted aggressive procedures and higher IOP predicted any procedure. Higher SVI was associated with a reduced likelihood of receiving minimally invasive procedures among rapid progressors (OR 0.05, 95% CI 0.00-0.76, p = 0.031).
Although rapid progression was a strong predictor of aggressive procedures, fewer than one in four underwent aggressive IOP-lowering interventions. Baseline IOP and structural severity appeared to supersede VF progression in clinical decisions. Patients in areas of higher socioeconomic vulnerability were also less likely to receive less invasive procedures. Better integrating rates of functional decline and addressing socioeconomic barriers may help optimize care for rapidly progressing glaucoma patients.
评估与青光眼患者快速视野（VF）进展时选择治疗方法相关的临床和社会人口统计学因素。
回顾性队列研究。
1812名成年人的2782只眼睛，这些成年人在五年内进行了5次或更多次24-2视野检查，且至少进行了一次光学相干断层扫描（OCT）。
快速进展者定义为平均偏差（MD）斜率低于-1 dB/年。收集人口统计学（年龄、性别、种族）、临床（眼压（IOP）、VF指标、OCT测量）和社会经济（社会脆弱性指数，或SVI）变量。根据前七年接受的最强化治疗对患者进行分类：药物治疗、微创治疗（如微创青光眼手术或激光治疗）或激进治疗（如滤过手术或睫状体破坏术）。进行逻辑回归以确定与治疗强度相关的人口统计学、临床和社会经济因素。
基于快速VF进展选择治疗方法的几率。
快速进展者接受激进治疗的几率显著更高（优势比[OR] 3.83，95%置信区间[CI] 2.56-5.74，p < 0.001）以及接受任何治疗的几率（OR 3.15，95% CI 2.28-4.35，p < 0.001），然而在头七年中只有23%的快速进展者接受了激进治疗。在快速进展者中，较差的MD和较小的视盘边缘面积预示着激进治疗，而较高的IOP预示着接受任何治疗。较高的SVI与快速进展者中接受微创治疗的可能性降低相关（OR 0.05，95% CI 0.00-0.76，p = 0.031）。
尽管快速进展是激进治疗的有力预测因素，但接受激进眼压降低干预的患者不到四分之一。在临床决策中，基线眼压和结构严重程度似乎取代了VF进展。社会经济脆弱性较高地区的患者接受侵入性较小治疗的可能性也较小。更好地整合功能下降率并解决社会经济障碍可能有助于优化对快速进展性青光眼患者的护理。
