Glaucoma With Early Visual Field Loss Affecting Both Hemifields and the Risk of Disease Progression

Objective: To evaluate whether damage to both hemifields in glaucomatous eyes predicts more rapid disease progression than does single-hemifield involvement. Methods: We reviewed the medical records of 43 660 consecutive patients. Eyes with glaucomatous optic neuropathy, 10 or more Swedish Interactive Threshold Algorithm standard 24-2 visual fields in at least 5 years, and mean deviation (MD) smaller than -6.0 dB were included. Pointwise linear regression was used to determine progression. Cox proportional hazards analysis was used to calculate risk of progression based on different baseline covariates. Results: We enrolled 205 eyes (205 patients; mean [SD] age, 64.2 [11.0] years; follow-up, 6.5 [1.8] years; number of visual fields, 12.3 [2.9]). Patients were divided into 3 groups: initial superior defect (group A; n = 79; MD, -3.4 [1.9] dB), initial inferior defect (group B; n = 61; MD, -3.4 [1.8] dB), and both hemifields affected (group C; n=65; MD, -4.2 [1.5] dB). Group C progressed faster than did groups A and B (P<.02). Multivariate analysis showed significant effect of higher baseline intraocular pressure, thinner central corneal thickness, and initial damage to both hemifields. Conclusions: Initial damage to both hemifields increases the risk of glaucoma progression. More aggressive therapy should be considered for these eyes.