Visual Field Progression in the Ocular Hypertension Treatment Study

Mae O Gordon; Dale K Heuer; Eve J Higginbotham; Richard K Parrish; Lei Liu; James D Brandt; Julia B Huecker; J Phillip Miller; Chamila Perera; Chris Xie; John L Keltner; Chris A Johnson; Stuart K Gardiner; Jeffrey M Liebmann; Michael A Kass

doi:10.1016/j.ajo.2024.11.017

Visual Field Progression in the Ocular Hypertension Treatment Study

Am J Ophthalmol. 2024 Dec 6:S0002-9394(24)00545-2. doi: 10.1016/j.ajo.2024.11.017. Online ahead of print.

Authors

Affiliations

¹ Washington University School of Medicine in St Louis, St Louis, Missouri.. Electronic address: [email protected].
² Medical College of Wisconsin, Milwaukee, Wisconsin.
³ University of Pennsylvania, Philadelphia, Pennsylvania.
⁴ University of Miami, Miami, Florida.
⁵ Washington University School of Medicine in St Louis, St Louis, Missouri.
⁶ University of California, Davis, California.
⁷ University of Michigan, Ann Arbor, Michigan.
⁸ University of Iowa, Iowa City, Iowa.
⁹ Devers Eye Institute, Portland, Oregon.
¹⁰ Columbia University Medical Center, New York, New York.

PMID: 39647569
DOI: 10.1016/j.ajo.2024.11.017

Abstract

Purpose: To determine the rate of visual field (VF) loss before and after the diagnosis of primary open angle glaucoma (POAG) in the Ocular Hypertension Treatment Study (OHTS).

Design: Pre-specified analyses of data collected prospectively in a clinical trial with extended follow-up.

Setting and participants: Participants who developed POAG during OHTS 1 and 2 (February 1994 to December 2008) constitute an inception cohort. Follow-up data were collected in OHTS 3 (January 2016 to April 2019). Analyses were performed from July 2021 to August 2022.

Intervention: In OHTS 1 and 2, visual field (VF) tests were performed every 6 months and stereoscopic optic disc photographs were taken every 12 months. These tests were repeated in OHTS 3.

Main outcomes and measures: Slopes of mean deviation (MD) were calculated by linear regression for all eyes in OHTS 1 and 2: eyes that did not develop POAG, eyes that developed optic disc POAG only, and eyes that developed VF POAG with/without optic disc POAG. Mean pre- and post-POAG slopes were calculated for eyes with a minimum of 5 VFs for each period.

Results: Mean age at diagnosis of POAG was 66.4 ± 9.5 SD years (n= 282 participants), (56%) were male, 61% were White non-Hispanic and 32% were Black not Hispanic by self-report. The post-POAG slope was -0.40 ± 0.64 SD dB/year for all POAG eyes (n=280 eyes), -0.19 ± 0.4 SD dB/yr. for optic disc POAG only eyes (n=112 eyes), and -0.54 ± 0.7 SD dB/yr. for VF POAG eyes with or without optic disc POAG (n=168 eyes). Among the VF POAG eyes, 69 (41%) had post-POAG MD slopes worse than or equal to -0.5 dB/year, 35 (21%) had slopes worse than or equal to -1.0 dB/year, and 9 (5.4%) had slopes worse than or equal to -2.0 dB/year.

Conclusions and relevance: Some participants in OHTS had rapid rates of VF loss in one or both eyes despite being followed in a clinical study. This emphasizes that ocular hypertensive patients require careful follow-up, especially those at high risk of developing POAG to ensure early diagnosis and appropriate treatment of POAG.