Rates of Visual Field Progression Before and After the Onset of Atrial Fibrillation

Précis: This case-control study investigated the effect of atrial fibrillation (AF) on the progression of glaucoma. The presence of AF and related microvascular damage was associated with a slightly faster visual field loss in glaucoma patients. Purpose: To investigate the effect of atrial fibrillation (AF) on glaucoma progression. Methods: In this longitudinal case-control study, a total of 144 eyes from 105 patients with primary open angle glaucoma were included. Forty-eight eyes of case developed AF during the follow-up followed for 15.6 years. Ninety-six eyes of control that did not have AF at baseline or during follow-up matched for age, baseline glaucoma severity, and follow-up period were followed for an average of 14.7 years. Mixed-effects linear models were used to calculate the difference in the VF MD slopes before and after the AF. CHADS 2 and CHA 2 DS 2 −VASc scores were used to evaluate the risk of thrombosis event, and related microvascular damage was assessed based on these scores. Results: The rate of VF MD change was −0.20 (−0.42 to 0.02) dB/y before AF and −0.28 (−0.47 to −0.09) dB/y after AF for the patients with AF, and −0.21 (−0.25 to −0.17) dB/y for the control. In the multivariable models, the VF slope difference before and after the onset of AF [−0.10 (−0.14 to −0.05) dB/y, P <0.001], higher CHADS 2 score [−0.07 (−0.13 to 0.00) dB/y per 1 unit, P =0.040], and higher CHA 2 DS 2 -VASc score [−0.05 (−0.10 to 0.00) dB/y per 1 unit, P =0.039] were associated with faster VF MD loss. Conclusions: The presence of atrial fibrillation and related microvascular damage might accelerate visual field loss. This underscores the need for a comprehensive medical history and management of cardiovascular risk factors to mitigate increased VF loss in glaucoma.