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Visual field progression patterns in the ocular hypertension treatment study correspond to vulnerability regions of the disc

Eye (2024)Cite this article

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Abstract

Objectives

To determine the locations on the 24-2 visual field (VF) testing grid that are most likely to progress in patients with ocular hypertension (OHTN). Based on a structural model of superior and inferior areas of relative vulnerability at the optic disc, we hypothesized that the nasal and paracentral regions are more prone to show a reduction in sensitivity.

Methods

Posthoc analysis of data collected in phases 1 and 2 of the Ocular Hypertension Treatment Study (OHTS). A pointwise analysis was applied to determine the progression patterns in the early and delayed treatment groups. Each group’s progression rate and frequency were calculated for each of the 52 locations corresponding to the 24-2 VF strategy, using trend- and event-based analyses, respectively.

Results

For the event-based analysis, the events were most commonly found in the nasal and paracentral regions. The same regions, with some modest variation, were found to have the fastest rates of progression (ROP) measured with trend analysis. A similar pattern of progression was observed in both the early and delayed treatment groups. The difference in event rates and ROP between the early and delayed treatment groups was also greatest in the nasal and paracentral regions.

Conclusions

Development of VF loss in ocular hypertensive eyes appears to be consistent with the vulnerability zones previously described in glaucomatous eyes with established VF loss. Ocular hypotensive treatment likely helps to slow the rate of progression in these regions. This suggests that careful monitoring of these locations may be useful.

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Fig. 1: The vulnerability zones model.
Fig. 2: Overview of the collected visual field data.
Fig. 3: Event based analysis.
Fig. 4: Trend based analysis.
Fig. 5: Treatment effect.

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Data availability

Data is available and will be provided upon reasonable request.

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Funding

Supported in part by the Jane and David Walentas Glaucoma Research Fund, Columbia University Department of Ophthalmology; an unrestricted grant to the Department of Ophthalmology, Columbia University Department of Ophthalmology from Research to Prevent Blindness, Inc., New York, NY USA; and Schur Family Glaucoma Fellowship (AL), Columbia University Department of Ophthalmology.

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Authors and Affiliations

  1. Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA

    Ari Leshno, Nikhil Bommakanti, Carlos Gustavo De Moraes, George A. Cioffi & Jeffrey M. Liebmann

  2. Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Ari Leshno

  3. Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Nikhil Bommakanti

  4. Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA

    Mae O. Gordon & Michael A. Kass

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Contributions

Conceptualization: NB, CGDM, JML; Data curation: NB, CGDM, JML, MOG, MAK; Formal analysis: AL, CGDM, NB; Investigation: AL, CGDM, JML, NB; Methodology: AL, JML, CGDM, MOG, MAK, GAC; Project administration: AL, JML, CGDM; Resources: GAC, CGDM and JML; Supervision: JML, GAC and CGDM; Validation: CGDM, MOG, MAK, GAC, JML; Writing – original draft: AL, JML, NB, CGDM; Writing - review & editing: AL, JML, NB, MOG, MAK, GAC, JML.

Corresponding author

Correspondence to Carlos Gustavo De Moraes.

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Competing interests

Carlos G. De Moraes: Carl Zeiss Meditec, Inc. (C); Novartis (C); Heidelberg Engineering (R); Topcon (F); Galimedix (C); Perfuse Therapeutics (C); Ora Clinical, Inc. (E) Jeffrey M. Liebmann: Novartis (R), Alcon (C), Allergan (C), Genentech (C), Thea (C).

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Leshno, A., Bommakanti, N., De Moraes, C.G. et al. Visual field progression patterns in the ocular hypertension treatment study correspond to vulnerability regions of the disc. Eye (2024). https://doi.org/10.1038/s41433-024-02949-x

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