Fast Progressors in Glaucoma: Prevalence Based on Global and Central Visual Field Loss

To determine the prevalence of fast global and central visual field (VF) progression in individuals with glaucoma under routine care.Observational study.Six hundred ninety-three eyes of 461 individuals with glaucoma followed up over a median 4.5 years.This study included (i) patients at a private ophthalmology clinic in Melbourne, Australia, and (ii) individuals in two prospective longitudinal observational studies across three sites in the USA. All individuals had glaucoma under routine care and had performed ≥5 reliable 24-2 VF tests over a 1- to 5-year period. Ordinary least squares regression analyses were used to calculate the rate of global mean deviation (MD) change over time, and of the mean total deviation values of the 12 locations within the central 10º region (MTD10), for each eye.Prevalence of progression based on the rate of MD and the MTD10 change across various fixed cut-offs and cut-offs based on the estimated normal distribution (from the positive slopes).Based on the MD and the MTD10, 12.5% and 11.7% of the eyes respectively exhibited a rate of change that was < -1.0dB/year (being a rate that is typically defined as "fast progression" for MD values), and 29.0% of the eyes showed a change of < -0.5dB/year on MTD10. Furthermore, 12.7% and 9.1% of the eyes exhibited a rate of change that exceeded the 1% cut-off of the estimated normal distribution MD and the MTD10 values respectively.This study found that approximately one in eight eyes with glaucoma under routine care showed fast progression based on global MD values (< -1.0dB/year), and nearly one in three eyes with < -0.5 dB/year decline centrally. These findings highlight the clinical importance of assessing progressive central visual field loss and reinforce the need for new therapies to prevent functional disability in a notable proportion of individuals who continue to exhibit fast progression.