Risk Factors Identified for Visual Function Decline in Eyes With Glaucoma

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Clinicians may wish to collaborate with physicians prescribing antihypertensive medications to minimize central vision field loss in their patients.

Significant risk factors for deterioration of central visual field in patients with advanced glaucoma are decreased best corrected visual acuity (BCVA), a larger β-peripapillary atrophy area (β-PPA)/disc area ratio, and the use of systemic antihypertensive agents, according to research published in Ophthalmology.  

In total, 175 eyes of 175 patients with advanced glaucoma (mean age 64.1 years) were assessed. All patients had well-controlled intraocular pressure (IOP) (mean baseline IOP 13.2 mm Hg; mean logMAR 0.02). Investigators performed the HFA 10-2 test and BCVA examination every 6 months, and the HFA 24-2 test every 12 months for 5 years (mean HFA: 24-2 and 10-2 MD,-25.9 and -22.9 decibels, respectively). They used the Cox proportional hazards model to identify risk factors for deterioration of central visual field and BCVA. The mean IOP was 13.0 mm Hg at follow-up. 

The researchers determined the probabilities of deterioration in HFA 10-2 and 24-2 results and BCVA were 0.269±0.043 (standard error), 0.173±0.031 and 0.194±0.033, respectively, at 5 years. 

Lower baseline BCVA (P =.012) was significantly associated with further deterioration of HFA 10-2 results. A higher mean deviation (MD) value of HFA24-2 (P <.001) and use of systemic antihypertensive agents (P =.009) were also significantly associated with further deterioration of HFA 24-2 results. Finally, a larger β-PPA/disc area ratio (P <.001), use of systemic antihypertensive agents (P =.025), and worsening BCVA (P =.042) were significantly associated with further deterioration of central vision.

“The current study suggests that greater β-PPA area/disc ratio and lower VA could be used as simple prognostic factors for the central VA of advanced glaucomatous eyes and that a medical history of hypertension should also be considered in the management of advanced glaucoma,” according to researchers.

Study limitations include the lack of a uniform treatment protocol, failure to assess the progression of the disease from a structural perspective, and the lack of applicability to patients with advanced glaucoma whose visual acuity is less than 20/40 due to damage from glaucoma.  

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Sugisaki K, Inoue T, Yoshikawa K, et al. Factors threatening central visual function of advanced glaucoma patients. Ophthalmol. Published online December 7, 2021. doi:10.1016/j.ophtha.2021.11.025