Abstract

Purpose To evaluate clinical and sociodemographic factors associated with selecting treatments in glaucoma patients with rapid visual field (VF) progression.

Design Retrospective cohort study Participants

2,583 eyes from 1,514 adults with 5 or more 24-2 visual fields over five years and at least one optical coherence tomography (OCT) scan.

Methods Rapid progressors were defined by mean deviation (MD) slopes worse than −1 dB/year. Demographic (age, gender, race), clinical (intraocular pressure (IOP), VF metrics, OCT measures), and socioeconomic (social vulnerability index, or SVI) variables were collected. Patients were categorized based on the most intensive treatment received in the first seven years: medical management, minimally invasive procedures (e.g., minimally invasive glaucoma surgery or laser), or aggressive procedures (e.g., filtering surgery or external ciliodestruction). Logistic regression was performed to identify demographic, clinical, and socioeconomic factors associated with treatment intensity.

Main Outcome Measures Odds of treatment selection based on rapid VF progression

Results Rapid progressors had significantly higher odds of receiving aggressive procedures (odds ratio [OR] 3.35, 95% confidence interval [CI] 2.12–5.30, p □ < □0.001) and any procedure (OR 2.74, 95% CI 1.87–4.01, p□< □0.001), yet only 15% of rapid progressors underwent aggressive procedures in the first seven years. Among rapid progressors, elevated IOP, worse MD, smaller rim area, and thinner retinal nerve fiber layer predicted aggressive or minimally invasive procedures, while lower IOP and milder damage reduced the likelihood. Higher SVI was associated with a reduced likelihood of receiving minimally invasive procedures among rapid progressors (OR 0.006, 95% CI 0.000–0.63, p□< □0.04).

Conclusion Although rapid progression was a strong predictor of aggressive procedures, fewer than one in five underwent aggressive IOP-lowering interventions. Baseline IOP and structural severity appeared to supersede VF progression in clinical decisions. Patients in areas of higher socioeconomic vulnerability were also less likely to receive less invasive procedures. Better integrating rates of functional decline and addressing socioeconomic barriers may help optimize care for rapidly progressing glaucoma patients.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

IRB of Johns Hopkins University gave ehitcal approval for this work

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Yes

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Footnotes

Meeting Presentation: This material has not been presented previously.

Financial Support: Supported by grants from the National Institute of Health 1K23EY032204- 03 and Research to Prevent Blindness Unrestricted Grant.

Proprietary Interest Statement: Jithin Yohannan is a consultant for Abbvie, Topcon and Ivantis/Alcon. Chris Bradley is a consultant for Radius XR. The authors have no conflicting proprietary or financial interests related to this manuscript.

Data Availability

All data produced in the present study are available upon reasonable request to the authors

Abbreviations and AcronymsADIArea Deprivation IndexCIConfidence IntervalCPTCurrent Procedural TerminologydBDecibelICDInternational Classification of DiseasesIOPIntraocular PressurelogMARLogarithm of the Minimum Angle of ResolutionMDMean DeviationMIGSMinimally Invasive Glaucoma SurgeryOCTOptical Coherence TomographyOROdds RatioRNFLRetinal Nerve Fiber LayerSITASwedish Interactive Thresholding AlgorithmSVISocial Vulnerability IndexVAVisual AcuityVFVisual FieldZIPZone Improvement Plan (ZIP Code)