Monitor Central VF to Catch Fast Progressors

The substantial proportion of eyes classified as fast progressing, especially in the central region for treated patients across all glaucoma severity groups, raises a major concern. Despite undergoing routine clinical care, a remarkable number of eyes at the advanced stage exhibited rapid progression in this critical area. The researchers believe this finding helps explain the persistence of glaucoma-related blindness, even among patients under clinical care. Photo: Brian D. Fisher, OD. Click image to enlarge. Considering the irreversible nature of ocular damage due to primary open-angle glaucoma (POAG) and its potential for lifetime functional impairment, assessing the disease progression rate in patients with glaucoma is a crucial aspect of disease management. Given the early involvement of glaucomatous damage in the central visual field (VF) and its key role in maintaining functionality, especially in advanced disease stages where functionality largely depends on preserving the remaining visual function, an enhanced understanding of the proportion of fast progressors across various glaucoma stages is of high clinical relevance.In a recent study published in American Journal of Ophthalmology, researchers evaluated the proportion of fast central VF progressors in individuals with POAG receiving routine clinical care across varying groups of glaucoma severity at baseline and compared proportion and agreement between central and global VF progression. They found that a greater proportion of eyes exhibited fast rates of progression in the central region of the visual field (defined by -0.5 dB/year) compared to the global VF across all glaucoma severity groups (10.8% in early glaucoma, 15.2% in moderate glaucoma and 20.9% in advanced glaucoma).A notable proportion of eyes (5.5% in early glaucoma, 6.6% in moderate glaucoma, and 15.1% in advanced glaucoma) showed fast rates of progression based on central mean total deviation but not VF mean deviation (MD).“Our results suggest that this approach may mask fast central VF progression in patients solely tested using the 24-2 strategy, potentially leading to delayed changes in care that may preserve vision,” the study authors wrote in their paper.This study included 1,117 eyes of 759 participants with POAG with at least five 24-2 VF tests over a minimum of two-year follow-up. Eyes were classified as early (> -6dB), moderate (-6dB to -12dB), and advanced (-12dB to -20dB) based on baseline VF MD. The slopes of global MD and central mean total deviation (12 test points within the central 10° region of the 24-2 VF test) were calculated. Proportions of fast progressors (≤ -1.0dB/year for MD and ≤ -0.5dB/year for central mean total deviation) in each glaucoma severity group were determined.Overall, 7.5% of eyes demonstrated fast rates of progression based on MD, while 12.8% of eyes showed fast rates of progression based on central mean total deviation. When eyes were stratified by baseline glaucoma severity, 6.9% (early), 11.1% (moderate), and 5.8% (advanced) of eyes exhibited fast rates of progression based on global MD. Fast progression based on MD was detected in isolation in a much smaller proportion of patients (1.7% in early glaucoma, 2.5% in moderate glaucoma, and none in advanced glaucoma).“Our findings reinforce the need for device manufacturers to consider integrating a metric of mean central visual sensitivity into existing progression analysis software,” the researchers suggested. This integration could notably enhance current clinical management by aiding in the identification of fast central VF progressors who may require a more intensive management approach or those who could benefit from follow-up testing with a 10-2 strategy.”They added that, until such a feature is integrated, qualitative monitoring of the central 12 points of the 24-2 VF test for progressive changes in the central VF in patients of all stages of glaucoma is essential.Click here for the journal source. Gunasegaran G, Moghimi S, Nishida T, et al. Proportion of fast progressors in the central vs. global visual field across varying glaucoma severity groups. Am J Ophthalmol. November 20, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.