What rates of glaucoma progression are clinically significant?

ABSTRACT

Introduction: Clinically important rates of glaucoma progression (worsening) are ones that put a patient at risk of future functional impairment or reduction of vision-related quality of life (VRQoL). Most treated eyes do not progress at rates that will lead to future visual impairment, but there are a significant proportion (3–17%) of eyes, that are at risk of impairment even under clinical care. While very fast rates of progression (e.g. MD progression of –1.5 dB/year) are generally problematic, much slower rates also may be deleterious for young patients, particularly those diagnosed with late disease.

Areas covered: This review provides an overview of what we know about rates of glaucomatous visual field and structural loss. It also summarizes the literature on what stage of vision loss affects vision related quality of life, and the value of predicting functional impairment based on life expectancy and severity of the disease.

Expert commentary: It is important to consider life expectancy, disease severity and vision-related quality of life based treatment targets to estimate future prognosis when evaluating whether a rate of glaucoma progression can be clinically relevant.

KEYWORDS:

• Glaucoma
• quality of life
• progression rates
• standard automated perimetry
• spectral domain optical coherence tomography
• confocal scanning laser ophthalmoscopy
• life expectancy

Declaration of interests

The authors were supported by grants received by NIH: P30EY022589, R01011008, R01EY019869, R01EY021818, R01EY025056 and by research to prevent blindness. L.M. Zangwill has received financial support from Carl Zeiss Meditech, Heidelberg Engineering, Optovue, Topcon Medical Systems and Quark Pharmaceuticals and has received research support from Carl Zeiss and Optovue. F.A Medeiros has received financial support from Carl Zeiss Meditech, Heidelberg Engineering, Topcon, Ametek, Bausch +Lomb, Allergan and Sensimed. F.A Medeiros is a consultant for Carl Zeiss Meditech, Heidelberg Engineering, Ametek, Alcon and Allergan and has received research support from Carl Zeiss Meditech. R.N Weinreb has received financial support from Heidelberg Engineering, Carl Zeiss Meditech, Genentech, Konan, National Eye Institute, Neurovision, Optovue, Quark, Reichert, Tomey and Topcon; is a consultant for Alcon, Allergan, Ametek, Bausch + Lomb, Carl Zeiss Meditec, Forsight, Topcon and Valeant and has received research support from Carl Zeiss Meditec. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.