Aims To provide population-based data on the maximum tolerable rate of progression to avoid visual impairment (maxTRoP_VI) and blindness (maxTRoP_BL) from open-angle glaucoma (OAG).
Methods Participants with OAG in the Thessaloniki Eye Study (cross-sectional, population-based study in a European population) were included in the analysis. Visual impairment was defined as mean deviation (MD) equal to or worse than −12 dB and blindness as MD equal to or worse than −24 dB. Additional thresholds for visual impairment were tested. For each participant maxTRoP_VI was defined as the rate of progression which would not lead to visual impairment during expected lifetime. MaxTRoP_BL was defined accordingly. Both parameters were calculated for each OAG subject using age, sex, MD and life expectancy data. The eye with the better MD per subject was included in the analysis.
Results Among 135 subjects with OAG, 123 had reliable visual fields and were included in the analysis. The mean age was 73±6 years and the median MD was −3.65±5.28 dB. Among those, 69.1% would have a maxTRoP_VI slower than −1 dB/year and 18.7% would have a maxTRoP_VI between −1 and −2 dB/year. Also, 72.4% would have a maxTRoP_BL slower than −2 dB/year. For all tested thresholds for visual impairment, approximately 86% of the OAG study participants would not be able to tolerate a rate of progression equal to or faster than −2 dB/year.
Conclusions The majority of patients with glaucoma in our study would have a maximum tolerable rate of progression slower than −1 dB/year in their better eye. Patient-tailored strategies to monitor the visual field are important, but raise the issue of feasibility with regard to the number of visual field tests needed.
- field of vision
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Contributors Conception/design of the study: AS, PF, VK, AA, FT. Data acquisition: EA, TP, AR, FT. Data analysis: AS, VK, AA, FT. Data interpretation: AS, PF, EA, TP, FT. Drafting the manuscript: AS, PF, FT. Revising the manuscript critically for important intellectual content: AS, PF, VK, AA, EA, TP, AR, FT. Final approval of the version to be published: AS, PF, VK, AA, EA, TP, AR, FT. Agreement to be accountable for all aspects of the work: AS, PF, VK, AA, EA, TP, AR, FT.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare no support from any organisation for the submitted work. AS has nothing to disclose. PF is a contributor to the extant European Glaucoma Society Guidelines and contributor and chapter co-author of the World Glaucoma Association consensus series published in 2016. VK has nothing to disclose. AA has nothing to disclose. EA has received grants from Allergan, Thea and Novartis and an honorarium from Allergan outside the submitted work. TP has received honoraria from Allergan and Novartis outside the submitted work. AR has nothing to disclose. FT has received grants and personal fees from Alcon, Novartis, Thea and Pfizer and personal fees from Bayer, Allergan and Santen outside the submitted work; he is also a member and chapter editor of the extant European Glaucoma Society Guidelines Development Task Force and a contributor and chapter editor of the extant World Glaucoma Association consensus series published in 2016, Lead of the Education Theme European Glaucoma Society (2016), Chair of the Program Planning Committee of the European Glaucoma Society and Co-Chair of the Education Committee of the European Glaucoma Society (2012), Member of the International Council of Ophthalmology Residency Curriculum Panel (2012), General Secretary of the Greek Glaucoma Society Board (2013), Member of the Committee of the European Board of Ophthalmology (EBO) Glaucoma Subspecialty examination (2015), Section Leader Glaucoma Education Center of the American Academy of Ophthalmology (2016), Co-Chair of the Program Planning Committee of the Glaucoma Research Society (2016) and Associate Editor of the Journal of Glaucoma (2017).
Patient consent Obtained.
Ethics approval Aristotle University Medical School Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement This analysis was based on data from the Thessaloniki Eye Study, and the dataset is available from the corresponding author at firstname.lastname@example.org. In the Thessaloniki Eye Study all necessary consents were obtained from the patients at recruitment, so consent for data sharing was not obtained. Moreover, all data were anonymised so risk of identification is low.
Correction notice This article has been corrected since it published Online First. Figure 1 has been replaced because in the original the dotted line for visual impairment in the graph was on -15dB when it should have been on -12 dB.
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