Characterization of Temporal Delay and Modeling of Intraocular Pressure and Visual Field Progression in the African Descent and Glaucoma Evaluation Study (ADAGES).

PURPOSE

Despite its utility, mathematical modeling of individualized intraocular pressure (IOP) goal has been hindered by the variable temporal relationships between IOP and visual field (VF) rate of progression (ROP). In this study, we fit a regression model after accounting for the temporal delays between IOP and ROP to help predict individual IOP goals.

DESIGN

This is a retrospective study analyzing the IOP-ROP temporal relationship and identifying predictive factors of IOP of stability.

PARTICIPANTS

408 eyes from the African Descent and Glaucoma Evaluation Study (ADAGES) with more than 14 VFs were included.

METHODS

For each eye, a ROP time series was produced and correlated to the IOP time series with incremental temporal shifts to estimate the delay between the two series. Average IOP during VF progression (worse than -0.5dB/year) and stability (better than -0.5dB/year) were calculated accounting for the delay. Contributing factors for IOP of stability (IOS) were analyzed using multivariable analysis, and significant factors were used to fit a regression model to help predict individualized IOP goal.

MAIN OUTCOME MEASURES

Temporal delay between IOP and ROP changes, and magnitude of error between the predicted IOS and the actual IOS.

RESULTS

Delay between IOP and VF changes was found to have a median of 7 months and mode of 4 months. Multivariable analysis found that thinner central corneal thickness (CCT; p < 0.001) and greater mean deviation (MD; p < 0.001) were associated with lower required IOP to maintain VF stability. Using CCT and MD, fitted regression models were able to predict individualized IOP that maintains VF stability within ±2-3mmHg.

CONCLUSIONS

ROP changes trail IOP changes by 4-7 months, an important consideration when obtaining additional VFs to capture or rule-out progression. Accounting for this delay, we modeled individualized IOS to within 2-3mmHg using only 2 clinical measures, CCT and MD. This simple IOP goal calculation will enable clinicians to make early treatment decisions prior to the delayed VF-based confirmation.