Age, Smoking Risk Factors for Long-term VF Decline in Exfoliative Glaucoma

Age and smoking are significant risk factors for long-term visual field decline in newly diagnosed exfoliative glaucoma patients. Other suggested risk factors include phakic status and lower CCT, which should be considered in the risk assessment at the time of diagnosis. Photo: Aaron Bronner, OD. Click image to enlarge. Evidence regarding long-term visual field progression in glaucoma studies is limited—patients are usually elderly at the time of initiation and cannot be observed over many years. Moreover, studies that focus solely on newly diagnosed glaucoma patients are rare, as most general glaucoma studies include both newly and previously diagnosed patients, and most have excluded those with exfoliative glaucoma (XFG). To help get better data on XFG patients, researchers from Sweden identified risk factors associated with visual field progression over long-term follow-up (10 years) in patients newly diagnosed with exfoliative glaucoma. They found that older age and smoking are the two biggest risk factors, recommending that older patients be monitored more frequently and that all patients be advised to stop smoking to potentially reduce the risk of further visual field decline. The findings were reported in Scientific Reports.Visual field progression was evaluated using three methods: mean deviation (MD), visual field index (VFI) and glaucoma progression analysis (GPA). Baseline variables to be evaluated included intraocular pressure (IOP), sex, age, visual fields, unilateral or bilateral presentation, visual acuity, lens status (phakic/pseudophakic), central corneal thickness (CCT), optic nerve status and gonioscopy findings. Additionally, a questionnaire was given on hypertension, diabetes, migraine, smoking and family history of glaucoma. Multivariable regression analyses were performed to identify risk factors.Among the 58 participants who completed the 10-year follow-up, 66% experienced visual field deterioration, while 34% did not. Older age at diagnosis and a history of smoking were consistently identified as significant risk factors for long-term visual field progression across all three models (MD, VFI and GPA).“We should closely monitor older patients, as they are more likely to develop more severe visual field defects than younger patients,” the authors noted in their paper. “Conversely, younger patients are expected to live longer and must be protected from significant glaucoma progression for a longer time. In the present study, a significant number of patients died or were in very poor condition (17% to 18%) during follow-up, which introduced some bias into the results.”Regarding smoking, the vast majority of the patients were former smokers, with only two patients described as current smokers at the time of inclusion. Most smoked in the age range of 20 to 40 and consumed around 10 cigarettes per day, and no “heavy smokers” were among the included patients. “Probably, the association between smoking and visual field progression in these patients was due to alterations in blood flow in the optic nerve or the retina,” the authors explained in their paper. “Interestingly, prior or current smoking was a significant predictor, even though only two patients were still smoking when the study started. Smoking probably caused permanent vascular changes that made the eyes more vulnerable even after the patients had stopped smoking.”In the MD model, phakic lens status and lower CCT were also found to be significant risk factors for progression. Phakic patients at inclusion showed an increased visual field progression than patients who were pseudophakic at inclusion. However, this finding should be interpreted with caution, as patients who had undergone cataract surgery exhibited lower IOP compared to those who remained phakic. Additionally, it is possible that cataract surgery facilitates the mechanical removal of exfoliation material, thereby reducing IOP and the risk of progression prior to study inclusion.What the authors found interesting is that IOP at the time of diagnosis was not a significant long-term risk factor, suggesting that the initial damaging effect of high IOP decreases over time with individualized glaucoma treatment.The authors noted that findings should be interpreted with caution due to the potential for selection bias and the fact that the study was conducted post hoc.Click here for the journal source. Ayala M, Dahlgren T. Risk factors for visual field progression during 10-year-follow-up in newly diagnosed exfoliation glaucoma patients. Sci Rep. June 30, 2026. [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.