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Rate of visual field decay in glaucomatous eyes with acquired pits of the optic nerve
  1. Golnoush Mahmoudinezhad1,
  2. Mark Lin1,
  3. Alessandro Rabiolo1,2,3,
  4. Esteban Morales1,
  5. Pradtana Hirunpatravong1,
  6. Farideh Sharifipour4,
  7. Joseph Caprioli1
  1. 1 Glaucoma Division, Jules Stein Eye Institute, University of California Los Angeles (UCLA), Los Angeles, California, USA
  2. 2 Department of Ophthalmology, Gloucestershire Hospitals NHS, Cheltenham, UK
  3. 3 School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
  4. 4 Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  1. Correspondence to Dr Joseph Caprioli, Ophthalmology, Jules Stein Eye Institute, Los Angeles, CA 90095, USA; Caprioli{at}


Background To evaluate the relationship between the presence of an acquired pit of the optic nerve (APON) and the rate of visual field (VF) decay in primary open-angle glaucoma (POAG).

Methods Consecutive patients with POAG were screened for APON by three glaucoma specialists. A control group of POAG eyes without APON were matched with the APON group for factors such as age, gender, baseline intraocular pressure and baseline mean deviation (MD). The pointwise rate of change (PRC) was used for pointwise comparisons between the two groups. MD rate, Visual Field Index (VFI) rate and Glaucoma Rate Index (GRI) were used for global rate comparisons. We compared the proportions of eyes progressing in the groups with event-based guided progression analysis (GPA), MD, VFI and GRI criteria.

Results Mean (SD) PRC was faster in the APON group −1.00 (±2.57) %/year compared with the control group −0.25 (±2.19) %/year; p<0.001. MD rate (−0.22 (±0.27) dB/year vs 0.03 (±0.41) dB/year; p=0.009), VFI rate (−0.81 (±0.86) %/year vs −0.05 (±1.0) %/year; p=0.04) and GRI (−12.27 (±16.27) vs -3.75 (±10.6); p=0.052) were all faster in the APON group compared with controls. The proportion of progressing eyes with GPA, MD, VFI and GRI was not significantly different between the two groups (p>0.1).

Conclusions The presence of APON in patients with POAG is associated with focal, fast rates of VF decay. Identification of patients with APON should alert clinicians to the possibility of a fast rate of functional progression and to consider appropriately aggressive treatment of their glaucoma.

  • glaucoma
  • optic nerve
  • intraocular pressure

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  • Contributors Study conception and design: JC. Collection of data: GM, ML, AR, EM, PH, FS. Statistical analysis: GM, EM. Interpretation of data: GM, ML, AR, EM, PH, FS, JC. Writing the article: GM, ML, AR. Critical revision of the article: GM, ML, AR, EM, PH, FS, JC. Final approval of the article: GM, ML, AR, EM, PH, FS, JC. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: GM, ML, AR, EM, PH, FS, JC. Guarantor: JC, GM.

  • Funding Research to Prevent Blindness, New York, New York; The Payden Glaucoma Research Fund, The Simms/Mann Family Foundation, NIH K23 5K23EY022659.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study were approved by the UCLA Institutional Review Board, adhered to the tenets outlined in the Declaration of Helsinki, and complied with Health Insurance Portability and Accountability Act regulations.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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