Risk factors for visual field progression in newly diagnosed exfoliation glaucoma patients in Sweden

Abstract

The present study aimed to identify risk factors for visual field progression in newly diagnosed exfoliation glaucoma patients. Prospective nonrandomized cohort study. The study included patients with newly diagnosed exfoliation glaucoma. All patients were followed for at least 3 years with reliable visual fields. Both risk factors at inclusion and during the 3-year follow-up were considered. For inclusion, five reliable visual fields were needed. Exfoliation glaucoma was defined based on the European Glaucoma Society guidelines. Visual field evaluation was performed using the 24–2 strategy of Humphrey field analysis. Outcomes: Visual field progression. Three different approaches were used: mean deviation, visual field index, and guided progression analysis. Independent variables were tested first in a univariate linear or regression model. The significant variables were retested in a multivariate linear or logistic regression model. The results were different for the MD, VFI and GPA models. The only variable that showed a significant association in the three models was age (p = 0.004; p = 0.006; p = 0.04). Significant variables in the two models were IOP at diagnosis (p = 0.02; p = 0.04), IOP reduction in absolute terms (p = 0.006; p = 0.003), IOP reduction in relative terms (%) (p = 0.04; p = 0.009) and number of medicines (p = 0.02; p = 0.002). Significant variables in one model were family history (p = 0.04), smoking (p = 0.03), cataract surgery (p = 0.04) and SLT treatment (p ≤ 0.001). Exfoliation glaucoma is a fast progressive glaucoma. Age at diagnosis must be considered. Significant IOP reduction must be achieved to slow down progress in exfoliation glaucoma. The use of SLT treatment should be advised in exfoliation glaucoma patients.