Change in Visual Field Progression Following Treatment Escalation in Primary Open-angle Glaucoma


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Abstract

Purpose:To evaluate the effect of treatment escalation on the rate of visual field progression in patients with primary open-angle glaucoma (POAG).Patients and Methods:Multicenter database study. We reviewed the electronic records of 171 patients with POAG under medical hypotensive treatment who underwent 5 consecutive visits 6 months apart before and after medical treatment escalation or additive laser trabeculoplasty. We calculated the rate of visual field progression (mean deviation change per year) before and after treatment escalation.Results:The mean duration of follow-up was 5.1±0.5 years and the mean number of visual field examinations was 10.2±0.2. In 139 eyes with medical treatment escalation, the rate of progression was significantly reduced [from −0.57 to −0.29 dB/y; P=0.022; intraocular pressure (IOP) reduction 11.1%]. In detail, the rate of progression was significantly reduced after escalation from mono to dual therapy, dual to triple therapy, and from mono to triple therapy (−0.35 to −0.24 dB/y, P=0.018; −1.01 to −0.48 dB/y, P=0.038; −1.04 to −0.35 dB/y, P=0.020, respectively). In 32 eyes with additive laser trabeculoplasty, the rate of progression was significantly reduced (−0.60 to −0.24 dB/y; P=0.014; IOP reduction 9.4%).Conclusions:Medical treatment escalation or additive laser trabeculoplasty significantly reduced the rate of visual field progression in POAG. Larger IOP reduction has a greater probability of reducing glaucoma progression.

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