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Editors Selection IGR 18-4

Clinical Forms of Glaucoma: Progression rates in various types of glaucoma

Comment by Marcello Nicolela on:

53254 Visual field progression outcomes in glaucoma subtypes, De Moraes CG; Liebmann JM; Liebmann CA et al., Acta Ophthalmologica, 2013; 91: 288-293

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In this manuscript, Moraes et al. evaluated visual field (VF) progression in different glaucoma subtypes within their clinical database. More specifically, they included patients with POAG, NTG, exfoliative glaucoma (XFG), pigmentary glaucoma, juvenile glaucoma, angle-closure glaucoma and glaucoma suspects. VF progression was assessed by pointwise linear regression analysis and global rates of VF loss. As with all retrospective studies, there are strengths and weaknesses in this manuscript. The large group of patients (841 patients) and the fact that they received state of the art treatment are among the strengths of this study. Among the weaknesses, we should be mindful of the (1) potential biases introduced by differential treatment in the various diagnostic groups; (2) missing data from patients who were lost to follow-up; and (3) the heterogeneity of the clinical population. This study showed that patients with XFG reached VF endpoint more frequently and had faster mean global rate of VF loss than patients in the other diagnostic groups, confirming previously published results. XFG was associated with VF progression in univariate logistic regression analysis (OR = 1.79, p = 0.01). In multivariate analysis, including parameters such as age, IOP, CCT, follow-up time, presence of disc hemorrhage and others, XFG was no longer significantly associated to VF progression, although the OR was still 1.64, close to statistical significance (p = 0.07). Unfortunately the authors did not include the full results of the multivariate analysis or the 95% confidence intervals of the OR. The authors concluded that there is no difference in progression among the different diagnostic groups once adjusted for the other variables related to progression in glaucoma. I would not dismiss XFG as an independent risk factor for progression based on these results, which could have been influenced by more aggressive treatment (more surgical and laser treatments) in patients with XFG compared to the other groups.

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