The Association Between Intraocular Pressure and Visual Field Worsening in Treated Glaucoma Patients.

PRECIS

In treated eyes with mild/suspect glaucoma, intraocular pressure (IOP) increments are associated with worsening mean deviation (MD) once IOP reaches the 20s. In moderate/advanced eyes, IOP increments are associated with worse visual field (VF) performance across the entire IOP range.

PURPOSE

The purpose of this study was to describe the relationship between mean treated IOP and VF worsening and understand how this relationship is affected by glaucoma severity and IOP range.

METHODS

A total of 1446 eyes of 869 treated glaucoma patients with at least 5 longitudinal reliable VF tests and IOP measures were included. Mixed-effects linear models were employed to understand the effect of eye-specific mean treated IOP on MD slope. Models included interaction terms to assess the differing relationships between MD slope and mean IOP by glaucoma severity (suspect/mild vs. moderate/advanced) and splines to account for the differing effects of mean IOP on MD slope at different IOP ranges (above or below 21 mm Hg).

RESULTS

In suspect/mild glaucoma, when treated IOP values were 0.05) but when treated IOP values rose >21 mm Hg, a 1 mm Hg increment in IOP was associated with faster VF worsening (-0.09 dB/y per 1 mm Hg increment, P21 mm Hg, P<0.05 for both).

CONCLUSION

IOP remained associated with VF worsening in eyes with more advanced glaucoma throughout the IOP range but was only associated with VF worsening in eyes with less severe glaucoma at higher IOP.