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Carlos Gustavo V. De Moraes, MD; Tiago S. Prata, MD; Celso Tello, MD; Robert Ritch, MD; Jeffrey M. Liebmann, MD

Arch Ophthalmol. 2009;127(9):1129-1134.

Objective  To evaluate whether damage to both hemifields in glaucomatous eyes predicts more rapid disease progression than does single-hemifield involvement.

Methods  We reviewed the medical records of 43 660 consecutive patients. Eyes with glaucomatous optic neuropathy, 10 or more Swedish Interactive Threshold Algorithm standard 24-2 visual fields in at least 5 years, and mean deviation (MD) smaller than –6.0 dB were included. Pointwise linear regression was used to determine progression. Cox proportional hazards analysis was used to calculate risk of progression based on different baseline covariates.

Results  We enrolled 205 eyes (205 patients; mean [SD] age, 64.2 [11.0] years; follow-up, 6.5 [1.8] years; number of visual fields, 12.3 [2.9]). Patients were divided into 3 groups: initial superior defect (group A; n = 79; MD, –3.4 [1.9] dB), initial inferior defect (group B; n = 61; MD, –3.4 [1.8] dB), and both hemifields affected (group C; n = 65; MD, –4.2 [1.5] dB). Group C progressed faster than did groups A and B (P < .02). Multivariate analysis showed significant effect of higher baseline intraocular pressure, thinner central corneal thickness, and initial damage to both hemifields.

Conclusions  Initial damage to both hemifields increases the risk of glaucoma progression. More aggressive therapy should be considered for these eyes.

Author Affiliations: Einhorn Clinical Research Center, Department of Ophthalmology, New York Eye and Ear Infirmary (Drs De Moraes, Prata, Tello, Ritch, and Liebmann); New York Medical College, Department of Ophthalmology (Drs Tello and Ritch); New York University School of Medicine, Department of Ophthalmology (Dr Liebmann); and Manhattan Eye, Ear, and Throat Hospital, Department of Ophthalmology (Dr Liebmann), New York.

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