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Abstract #107840 Published in IGR 23-4
Five-Year Visual Field Outcomes of the HORIZON Trial
Montesano G; Ometto G; Ahmed IIK; Ramulu PY; Chang DF; Crabb DP; Gazzard GAmerican Journal of Ophthalmology 2023; 251: 143-155
PURPOSE: To compare visual field (VF) progression between glaucoma patients receiving cataract surgery alone (CS) or with a Hydrus microstent (CS-HMS). DESIGN: Post hoc analysis of VF data from the HORIZON multicenter randomized controlled trial. METHODS: A total of 556 patients with glaucoma and cataract were randomized 2:1 to either CS-HMS (369) or CS (187) and followed up for 5 years. VF was performed at 6 months and then every year after surgery. We analyzed data for all participants with at least 3 reliable VFs (false positives < 15%). Average between-group difference in rate of progression (RoP) was tested using a Bayesian mixed model and a 2-sided Bayesian P value <.05 (main outcome). A multivariable model measured the effect of intraocular pressure (IOP). A survival analysis compared the probability of global VF sensitivity dropping by predefined cutoffs (2.5, 3.5, 4.5, and 5.5 dB) from baseline. RESULTS: Data from 352 eyes in the CS-HMS arm and 165 in the CS arm were analyzed (2966 VFs). The mean RoP was -0.26 dB/y (95% credible interval -0.36, -0.16) for CS-HMS and -0.49 dB/y (95% credible interval -0.63, -0.34) for CS. This difference was significant (P = .0138). The difference in IOP only explained 17% of the effect (P < .0001). Five-year survival analysis showed an increased probability of VF worsening by 5.5 dB (P = .0170), indicating a greater proportion of fast progressors in the CS arm. CONCLUSIONS: CS-HMS has a significant effect on VF preservation in glaucoma patients compared with CS alone, reducing the proportion of fast progressors.
NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (G.M., G.O., G.G.), London, United Kingdom; City, University of London-Optometry and Visual Sciences (G.M., G.O., D.P.C.), London, United Kingdom. Electronic address: giovmontesano@gmail.com.
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