Baseline 24-2 Central Visual Field Damage Is Predictive of Global Progressive Field Loss

Aakriti Garg; C. Gustavo De Moraes; George A. Cioffi; Christopher A. Girkin; Felipe A. Medeiros; Robert N. Weinreb; Linda M. Zangwill; Jeffrey M. Liebmann

doi:10.1016/j.ajo.2018.01.001

Baseline 24-2 Central Visual Field Damage Is Predictive of Global Progressive Field Loss

Aakriti Garg, C. Gustavo De Moraes, George A. Cioffi, Christopher A. Girkin, Felipe A. Medeiros, Robert N. Weinreb, Linda M. Zangwill, Jeffrey M. Liebmann

School of Medicine

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Purpose: Central visual field (VF) damage in glaucoma patients can significantly hinder daily activities. The present study investigates whether the presence of localized baseline damage to the central 10 degrees of the VF is predictive of faster global mean deviation (MD) progression. Design: Prospective cohort study. Methods: Eyes from the multicenter African Descent and Glaucoma Evaluation Study (ADAGES) with established glaucoma and VF loss and a minimum of 5 24-2 VFs were eligible. Baseline central 24-2 damage was defined as any of the 12 central-most points with total deviation (TD) values at P < 0.5% on 2 consecutive examinations. Progression was determined using trend-based and event-based criteria: (1) rates of MD change significantly faster than zero and (2) >−5 dB MD loss over the entire follow-up. Results: A total of 827 eyes of 584 patients were studied. Mean rate of MD change of the entire sample was −0.15 dB/year (95% CI: −0.19 to −0.12, P <.001). Eyes with baseline central damage progressed faster than those without (difference: β_central = −0.07 dB/year, 95% CI: −0.11 to −0.01, P =.011) and were more likely to experience MD loss greater than 5 dB (hazard ratio = 3.0 [95% CI: 2.1–4.1, P <.001]). These differences remained significant after adjusting for confounders. Conclusion: The presence of central VF damage at baseline is significantly associated with more rapid global progression. Detection of central VF damage aids in stratification of high-risk patients who may need intensive surveillance and aggressive treatment.

Original language	English (US)
Pages (from-to)	92-98
Number of pages	7
Journal	American journal of ophthalmology
Volume	187
DOIs	https://doi.org/10.1016/j.ajo.2018.01.001
State	Published - Mar 2018

ASJC Scopus subject areas

Ophthalmology

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10.1016/j.ajo.2018.01.001

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@article{73e891addc4648bd946734691526d979,

title = "Baseline 24-2 Central Visual Field Damage Is Predictive of Global Progressive Field Loss",

abstract = "Purpose: Central visual field (VF) damage in glaucoma patients can significantly hinder daily activities. The present study investigates whether the presence of localized baseline damage to the central 10 degrees of the VF is predictive of faster global mean deviation (MD) progression. Design: Prospective cohort study. Methods: Eyes from the multicenter African Descent and Glaucoma Evaluation Study (ADAGES) with established glaucoma and VF loss and a minimum of 5 24-2 VFs were eligible. Baseline central 24-2 damage was defined as any of the 12 central-most points with total deviation (TD) values at P < 0.5% on 2 consecutive examinations. Progression was determined using trend-based and event-based criteria: (1) rates of MD change significantly faster than zero and (2) >−5 dB MD loss over the entire follow-up. Results: A total of 827 eyes of 584 patients were studied. Mean rate of MD change of the entire sample was −0.15 dB/year (95% CI: −0.19 to −0.12, P <.001). Eyes with baseline central damage progressed faster than those without (difference: βcentral = −0.07 dB/year, 95% CI: −0.11 to −0.01, P =.011) and were more likely to experience MD loss greater than 5 dB (hazard ratio = 3.0 [95% CI: 2.1–4.1, P <.001]). These differences remained significant after adjusting for confounders. Conclusion: The presence of central VF damage at baseline is significantly associated with more rapid global progression. Detection of central VF damage aids in stratification of high-risk patients who may need intensive surveillance and aggressive treatment.",

author = "Aakriti Garg and {De Moraes}, {C. Gustavo} and Cioffi, {George A.} and Girkin, {Christopher A.} and Medeiros, {Felipe A.} and Weinreb, {Robert N.} and Zangwill, {Linda M.} and Liebmann, {Jeffrey M.}",

note = "Funding Information: This prospective cohort study demonstrates that baseline central VF loss as measured with the 24-2 VF testing strategy was predictive of more rapid and significant progression of global field damage in eyes with manifest glaucoma. Our findings may have significant clinical implications for closer surveillance as well as more aggressive treatment of glaucoma patients with central VF loss. To our knowledge, the present analysis is the first to prospectively study the effects of central VF damage on global field progression over time in patients with manifest glaucoma. The main goal of glaucoma therapy is to preserve visual function and quality of life. We found that the presence of baseline central 24-2 damage increases the likelihood of experiencing MD loss > 5 dB (an amount of change known to significantly affect quality of life 13,14 ) by 3-fold compared to those without baseline central damage. The strong association between baseline central visual damage and progression of global VF damage demonstrates that these eyes are at greater risk of more rapid global progression. Furthermore, Abe and associates recently demonstrated greater declines in National Eye Institute Visual Functioning Questionnaire 25 scores in those patients who had worse central VF sensitivity at baseline. 9 We employed several strategies to overcome the potential bias of trying to analyze the effect of central VF damage on VF progression, as central and global VF damage are strongly correlated. First, as a stronger weighting of central field points on global indices could bias our results, we also assessed rates of MSD change. We also found statistically significant effects in both MD and MSD. These differences between the various global indices should be taken into consideration in future studies assessing VF outcomes. Second, we also tried to minimize the effect of differences in baseline MD as a confounder on MD rates of change by performing a multivariable analysis that adjusts for baseline MD and differences in slopes between eyes with more vs less severe MD (represented by the variable “Baseline MD” and its interaction “Baseline MD × Time,” respectively). Finally, we investigated whether eyes with nasal field defects (meeting the same criteria of abnormality as those with central defects) progressed faster than those without nasal defects. Our rationale for this analysis was that the location of the defect—and not only the overall severity of the VF defect—predicts future progression. This type of analysis is also important, as many eyes have both nasal and central defects ( Table 2 ). Even though eyes with nasal defects progressed faster than those without it, when both groups (nasal and central) were entered together in the same model, only central defects remained significant, suggesting not only the importance of VF severity but, more importantly, the location of the defect. The results of all the analyses described above provide consistent evidence that baseline central damage predicts global VF MD progression independent of worse overall VF damage found in patients with central loss. Progression of global VF loss associated with baseline central damage has also been evaluated in a retrospective study of normal tension glaucoma by Membrey and associates. 4 In this study, central field loss was defined as presence of a cluster of at least 3 points in 1 hemifield depressed by −5 dB, with at least 1 point depressed by >10 dB in the 4 paracentral locations. Progression was defined as −1 dB per year or more of sensitivity loss at the same test location. The authors found that eyes with baseline threats to fixation tended to progress more rapidly globally, although this was not statistically significant ( P = .18). 4 Additionally, in a retrospective study with normal tension glaucoma patients, Cho and associates compared the rates of sensitivity change between eyes with initial paracentral defects and initial peripheral defects. No significant differences were found in testing sectoral and global rates of change between the 2 groups. 18 Furthermore, Nassiri and associates used pointwise event analysis to study glaucomatous eyes with a mean baseline MD of −4.2 ± 4.5 dB and found that rates of decay were faster in the central 10 degrees surrounding fixation compared to 20-degree and 30-degree regions. 19 Differences in study design, samples, and definitions of central VF and progression may explain, at least in part, inconsistencies between our findings and those cited above. Other reports have explored patterns of damage in the VF and their association with more rapid progression. Shon and associates proposed that superior arcuate as well as superior and inferior nasal areas may be best able to predict future VF deterioration, as these regions demonstrated the most consistent rate of reduction in retinal sensitivity. In this study, reduction of central sensitivity was found to be variable between the early and late follow-up period. 20 Although this report offers useful insight into VF progression, we cannot definitively conclude that a consistent rate of progression in any given area makes it a solid predictor for overall progression. Additionally, this study used 24-2 VFs to study the macular region; inconsistent results in this region may be attributable to variable sampling of the damage in this region. Our study found that central VF defects are linked to a faster decline in global progression of the field. It is known that decline in visual function has a significant effect on quality of life. 5,6,13,14 Abe and associates reported that reduction of sensitivity in the central inferior region of the 24-2 VF was found to have the highest association with decline in vision-related quality of life. 9 This association between central damage, decline in quality of life, and faster global progression can have significant ramifications for patients and requires physicians to pay special attention to changes in the central VF. Furthermore, the vulnerability of the central field to elevated pressures 21 calls for a more aggressive treatment regimen in the setting of central loss. Our analysis used only the 24-2 strategy to study the central VF; however, previous studies have found that central visual damage can be missed with 24-2 fields. 22 Despite this potential disadvantage of 24-2 tests to detect central VF loss, clinicians more commonly use 24-2 over 10-2 testing to monitor progression in glaucoma patients. Therefore, our findings using 24-2 fields have more direct clinical applicability. Nonetheless, our results need to be further validated with a long-term study using both 24-2 and 10-2 testing strategies. Additionally, proposed reasons for macular loss in glaucoma include nasalization of the central retinal vessel trunk, 23 axonal crowding at the inferior and superior poles of the nerve, 24 and the enlargement of lamina cribrosa pores and associated loss of structural support in these regions. 25 Further investigations to corroborate these anatomic changes with functional testing would be useful. Of note, our results suggest an association between central functional loss and rates of global visual field progression. A causal relationship cannot be inferred from our results, and future studies ought to address this matter. In conclusion, the presence of central VF damage is significantly associated with increased velocity of global VF progression. Detection of central VF damage aids in stratification of high-risk patients who may need more intensive surveillance and aggressive treatment. Funding/Support: National Eye Institute Grants: U10EY14267, EY08208, EY11008, EY019869, EY13959, 1EY027510, EY025253 (C.G.D.M.), Bethesda, Maryland; Eyesight Foundation of Alabama, Birmingham, Alabama; Alcon Laboratories Inc, Fort Worth, Texas; Allergan Inc, Dublin, Ireland; Pfizer Inc, New York, New York; Merck Inc, Rahway, New Jersey; Santen Inc, Osaka, Japan; unrestricted departmental grant from Research to Prevent Blindness, New York, New York (Department of Ophthalmology, Columbia University Medical Center and Department of Ophthalmology, University of California San Diego); Edith C. Blum Foundation, New York, New York; Bernard Schwartz Travel Grant from the American Glaucoma Society, San Francisco, California. George A. Cioffi has no financial disclosures aside from a grant from the foundation Research to Prevent Blindness, New York, New York. Financial Disclosures: Christopher A. Girkin: Research support – Heidelberg Engineering GmbH, Heidelberg, Germany; Felipe A. Medeiros: Financial support – Alcon Laboratories Inc, Fort Worth, Texas, Carl Zeiss Meditec Inc, Jena, Germany, Pfizer Inc, New York, NY; Consultant – Alcon Laboratories Inc, Allergan Inc, Dublin, Ireland, Pfizer Inc; Research support – Alcon Laboratories Inc, Allergan Inc, Carl Zeiss Meditec Inc, Pfizer Inc, Reicherts Inc, Depew, New York; Robert N. Weinreb: Financial support – Carl Zeiss Meditec Inc, Jena, Germany, Heidelberg Engineering GmbH, Heidelberg, Germany, Optovue Inc, Fremont, California, Topcon Medical Systems, Tokyo, Japan; Consultant–Aerie Pharmaceuticals, Pittsburgh, Pennsylvania, Alcon Laboratories Inc, Fort Worth, Texas, Allergan Inc, Dublin, Ireland, Bausch & Lomb, Unity, Garden City, New York; Grants–Quark Pharmaceuticals, Inc, Ness Ziona, Israel, Genentech, San Francisco, California; Linda M. Zangwill: Research support and equipment – Carl Zeiss Meditec Inc, Jena, Germany, Heidelberg Engineering GmbH, Heidelberg, Germany, Optovue Inc, Fremont, California, Topcon Medical Systems Inc, Tokyo, Japan; Jeffrey M. Liebmann: Consultant–Sensimed, Inc, Lausanne, Switzerland, Carl Zeiss Meditec, Inc, Jena, Germany, Alcon Laboratories, Fort Worth, Texas, Topcon, Inc, Tokyo, Japan, Heidelberg Engineering, GmbH, Heidelberg, Germany, Allergan, Inc, Dublin, Ireland, Bausch & Lomb, Inc, Garden City, New York, Aerie Pharmaceuticals, Inc, Pittsburgh, Pennsylvania, Quark Pharmaceuticals, Inc, Ness Ziona, Israel. The following authors have no financial disclosures: Aakriti Garg and C. Gustavo De Moraes. All authors attest that they meet the current ICMJE criteria for authorship. Publisher Copyright: {\textcopyright} 2018 Elsevier Inc.",

year = "2018",

month = mar,

doi = "10.1016/j.ajo.2018.01.001",

language = "English (US)",

volume = "187",

pages = "92--98",

journal = "American journal of ophthalmology",

issn = "0002-9394",

publisher = "Elsevier USA",

}

TY - JOUR

T1 - Baseline 24-2 Central Visual Field Damage Is Predictive of Global Progressive Field Loss

AU - Garg, Aakriti

AU - De Moraes, C. Gustavo

AU - Cioffi, George A.

AU - Girkin, Christopher A.

AU - Medeiros, Felipe A.

AU - Weinreb, Robert N.

AU - Zangwill, Linda M.

AU - Liebmann, Jeffrey M.

N1 - Funding Information: This prospective cohort study demonstrates that baseline central VF loss as measured with the 24-2 VF testing strategy was predictive of more rapid and significant progression of global field damage in eyes with manifest glaucoma. Our findings may have significant clinical implications for closer surveillance as well as more aggressive treatment of glaucoma patients with central VF loss. To our knowledge, the present analysis is the first to prospectively study the effects of central VF damage on global field progression over time in patients with manifest glaucoma. The main goal of glaucoma therapy is to preserve visual function and quality of life. We found that the presence of baseline central 24-2 damage increases the likelihood of experiencing MD loss > 5 dB (an amount of change known to significantly affect quality of life 13,14 ) by 3-fold compared to those without baseline central damage. The strong association between baseline central visual damage and progression of global VF damage demonstrates that these eyes are at greater risk of more rapid global progression. Furthermore, Abe and associates recently demonstrated greater declines in National Eye Institute Visual Functioning Questionnaire 25 scores in those patients who had worse central VF sensitivity at baseline. 9 We employed several strategies to overcome the potential bias of trying to analyze the effect of central VF damage on VF progression, as central and global VF damage are strongly correlated. First, as a stronger weighting of central field points on global indices could bias our results, we also assessed rates of MSD change. We also found statistically significant effects in both MD and MSD. These differences between the various global indices should be taken into consideration in future studies assessing VF outcomes. Second, we also tried to minimize the effect of differences in baseline MD as a confounder on MD rates of change by performing a multivariable analysis that adjusts for baseline MD and differences in slopes between eyes with more vs less severe MD (represented by the variable “Baseline MD” and its interaction “Baseline MD × Time,” respectively). Finally, we investigated whether eyes with nasal field defects (meeting the same criteria of abnormality as those with central defects) progressed faster than those without nasal defects. Our rationale for this analysis was that the location of the defect—and not only the overall severity of the VF defect—predicts future progression. This type of analysis is also important, as many eyes have both nasal and central defects ( Table 2 ). Even though eyes with nasal defects progressed faster than those without it, when both groups (nasal and central) were entered together in the same model, only central defects remained significant, suggesting not only the importance of VF severity but, more importantly, the location of the defect. The results of all the analyses described above provide consistent evidence that baseline central damage predicts global VF MD progression independent of worse overall VF damage found in patients with central loss. Progression of global VF loss associated with baseline central damage has also been evaluated in a retrospective study of normal tension glaucoma by Membrey and associates. 4 In this study, central field loss was defined as presence of a cluster of at least 3 points in 1 hemifield depressed by −5 dB, with at least 1 point depressed by >10 dB in the 4 paracentral locations. Progression was defined as −1 dB per year or more of sensitivity loss at the same test location. The authors found that eyes with baseline threats to fixation tended to progress more rapidly globally, although this was not statistically significant ( P = .18). 4 Additionally, in a retrospective study with normal tension glaucoma patients, Cho and associates compared the rates of sensitivity change between eyes with initial paracentral defects and initial peripheral defects. No significant differences were found in testing sectoral and global rates of change between the 2 groups. 18 Furthermore, Nassiri and associates used pointwise event analysis to study glaucomatous eyes with a mean baseline MD of −4.2 ± 4.5 dB and found that rates of decay were faster in the central 10 degrees surrounding fixation compared to 20-degree and 30-degree regions. 19 Differences in study design, samples, and definitions of central VF and progression may explain, at least in part, inconsistencies between our findings and those cited above. Other reports have explored patterns of damage in the VF and their association with more rapid progression. Shon and associates proposed that superior arcuate as well as superior and inferior nasal areas may be best able to predict future VF deterioration, as these regions demonstrated the most consistent rate of reduction in retinal sensitivity. In this study, reduction of central sensitivity was found to be variable between the early and late follow-up period. 20 Although this report offers useful insight into VF progression, we cannot definitively conclude that a consistent rate of progression in any given area makes it a solid predictor for overall progression. Additionally, this study used 24-2 VFs to study the macular region; inconsistent results in this region may be attributable to variable sampling of the damage in this region. Our study found that central VF defects are linked to a faster decline in global progression of the field. It is known that decline in visual function has a significant effect on quality of life. 5,6,13,14 Abe and associates reported that reduction of sensitivity in the central inferior region of the 24-2 VF was found to have the highest association with decline in vision-related quality of life. 9 This association between central damage, decline in quality of life, and faster global progression can have significant ramifications for patients and requires physicians to pay special attention to changes in the central VF. Furthermore, the vulnerability of the central field to elevated pressures 21 calls for a more aggressive treatment regimen in the setting of central loss. Our analysis used only the 24-2 strategy to study the central VF; however, previous studies have found that central visual damage can be missed with 24-2 fields. 22 Despite this potential disadvantage of 24-2 tests to detect central VF loss, clinicians more commonly use 24-2 over 10-2 testing to monitor progression in glaucoma patients. Therefore, our findings using 24-2 fields have more direct clinical applicability. Nonetheless, our results need to be further validated with a long-term study using both 24-2 and 10-2 testing strategies. Additionally, proposed reasons for macular loss in glaucoma include nasalization of the central retinal vessel trunk, 23 axonal crowding at the inferior and superior poles of the nerve, 24 and the enlargement of lamina cribrosa pores and associated loss of structural support in these regions. 25 Further investigations to corroborate these anatomic changes with functional testing would be useful. Of note, our results suggest an association between central functional loss and rates of global visual field progression. A causal relationship cannot be inferred from our results, and future studies ought to address this matter. In conclusion, the presence of central VF damage is significantly associated with increased velocity of global VF progression. Detection of central VF damage aids in stratification of high-risk patients who may need more intensive surveillance and aggressive treatment. Funding/Support: National Eye Institute Grants: U10EY14267, EY08208, EY11008, EY019869, EY13959, 1EY027510, EY025253 (C.G.D.M.), Bethesda, Maryland; Eyesight Foundation of Alabama, Birmingham, Alabama; Alcon Laboratories Inc, Fort Worth, Texas; Allergan Inc, Dublin, Ireland; Pfizer Inc, New York, New York; Merck Inc, Rahway, New Jersey; Santen Inc, Osaka, Japan; unrestricted departmental grant from Research to Prevent Blindness, New York, New York (Department of Ophthalmology, Columbia University Medical Center and Department of Ophthalmology, University of California San Diego); Edith C. Blum Foundation, New York, New York; Bernard Schwartz Travel Grant from the American Glaucoma Society, San Francisco, California. George A. Cioffi has no financial disclosures aside from a grant from the foundation Research to Prevent Blindness, New York, New York. Financial Disclosures: Christopher A. Girkin: Research support – Heidelberg Engineering GmbH, Heidelberg, Germany; Felipe A. Medeiros: Financial support – Alcon Laboratories Inc, Fort Worth, Texas, Carl Zeiss Meditec Inc, Jena, Germany, Pfizer Inc, New York, NY; Consultant – Alcon Laboratories Inc, Allergan Inc, Dublin, Ireland, Pfizer Inc; Research support – Alcon Laboratories Inc, Allergan Inc, Carl Zeiss Meditec Inc, Pfizer Inc, Reicherts Inc, Depew, New York; Robert N. Weinreb: Financial support – Carl Zeiss Meditec Inc, Jena, Germany, Heidelberg Engineering GmbH, Heidelberg, Germany, Optovue Inc, Fremont, California, Topcon Medical Systems, Tokyo, Japan; Consultant–Aerie Pharmaceuticals, Pittsburgh, Pennsylvania, Alcon Laboratories Inc, Fort Worth, Texas, Allergan Inc, Dublin, Ireland, Bausch & Lomb, Unity, Garden City, New York; Grants–Quark Pharmaceuticals, Inc, Ness Ziona, Israel, Genentech, San Francisco, California; Linda M. Zangwill: Research support and equipment – Carl Zeiss Meditec Inc, Jena, Germany, Heidelberg Engineering GmbH, Heidelberg, Germany, Optovue Inc, Fremont, California, Topcon Medical Systems Inc, Tokyo, Japan; Jeffrey M. Liebmann: Consultant–Sensimed, Inc, Lausanne, Switzerland, Carl Zeiss Meditec, Inc, Jena, Germany, Alcon Laboratories, Fort Worth, Texas, Topcon, Inc, Tokyo, Japan, Heidelberg Engineering, GmbH, Heidelberg, Germany, Allergan, Inc, Dublin, Ireland, Bausch & Lomb, Inc, Garden City, New York, Aerie Pharmaceuticals, Inc, Pittsburgh, Pennsylvania, Quark Pharmaceuticals, Inc, Ness Ziona, Israel. The following authors have no financial disclosures: Aakriti Garg and C. Gustavo De Moraes. All authors attest that they meet the current ICMJE criteria for authorship. Publisher Copyright: © 2018 Elsevier Inc.

PY - 2018/3

Y1 - 2018/3

N2 - Purpose: Central visual field (VF) damage in glaucoma patients can significantly hinder daily activities. The present study investigates whether the presence of localized baseline damage to the central 10 degrees of the VF is predictive of faster global mean deviation (MD) progression. Design: Prospective cohort study. Methods: Eyes from the multicenter African Descent and Glaucoma Evaluation Study (ADAGES) with established glaucoma and VF loss and a minimum of 5 24-2 VFs were eligible. Baseline central 24-2 damage was defined as any of the 12 central-most points with total deviation (TD) values at P < 0.5% on 2 consecutive examinations. Progression was determined using trend-based and event-based criteria: (1) rates of MD change significantly faster than zero and (2) >−5 dB MD loss over the entire follow-up. Results: A total of 827 eyes of 584 patients were studied. Mean rate of MD change of the entire sample was −0.15 dB/year (95% CI: −0.19 to −0.12, P <.001). Eyes with baseline central damage progressed faster than those without (difference: βcentral = −0.07 dB/year, 95% CI: −0.11 to −0.01, P =.011) and were more likely to experience MD loss greater than 5 dB (hazard ratio = 3.0 [95% CI: 2.1–4.1, P <.001]). These differences remained significant after adjusting for confounders. Conclusion: The presence of central VF damage at baseline is significantly associated with more rapid global progression. Detection of central VF damage aids in stratification of high-risk patients who may need intensive surveillance and aggressive treatment.

AB - Purpose: Central visual field (VF) damage in glaucoma patients can significantly hinder daily activities. The present study investigates whether the presence of localized baseline damage to the central 10 degrees of the VF is predictive of faster global mean deviation (MD) progression. Design: Prospective cohort study. Methods: Eyes from the multicenter African Descent and Glaucoma Evaluation Study (ADAGES) with established glaucoma and VF loss and a minimum of 5 24-2 VFs were eligible. Baseline central 24-2 damage was defined as any of the 12 central-most points with total deviation (TD) values at P < 0.5% on 2 consecutive examinations. Progression was determined using trend-based and event-based criteria: (1) rates of MD change significantly faster than zero and (2) >−5 dB MD loss over the entire follow-up. Results: A total of 827 eyes of 584 patients were studied. Mean rate of MD change of the entire sample was −0.15 dB/year (95% CI: −0.19 to −0.12, P <.001). Eyes with baseline central damage progressed faster than those without (difference: βcentral = −0.07 dB/year, 95% CI: −0.11 to −0.01, P =.011) and were more likely to experience MD loss greater than 5 dB (hazard ratio = 3.0 [95% CI: 2.1–4.1, P <.001]). These differences remained significant after adjusting for confounders. Conclusion: The presence of central VF damage at baseline is significantly associated with more rapid global progression. Detection of central VF damage aids in stratification of high-risk patients who may need intensive surveillance and aggressive treatment.

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DO - 10.1016/j.ajo.2018.01.001

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JO - American journal of ophthalmology

JF - American journal of ophthalmology

ER -

Baseline 24-2 Central Visual Field Damage Is Predictive of Global Progressive Field Loss

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