Incidence and Risk Factors of Recurrent Visual Field Progression in Glaucoma
Year: 2026
Type: article
Study design: Observational Study
Abstract: Importance: A confirmed visual field progression event in glaucoma typically prompts intensification of intraocular pressure (IOP)-lowering therapy, yet the factors associated with recurrent progression after that first event remain poorly characterized. Objective: To evaluate the incidence of recurrent visual field progression after an initial Guided Progression Analysis (GPA) likely-progression event and the factors associated with a recurrent event. Design, Setting, and Participants: This cohort study was conducted among patients receiving routine ophthalmic care between 1998 and 2025 at a single tertiary academic center (Bascom Palmer Ophthalmic Registry). Data were analyzed from February 2026 to August 2026. Main Outcomes and Measures: The primary outcomes were the cumulative probability of recurrent visual field progression and hazard ratios (HRs) for factors associated with recurrence. Results: A total of 7457 eyes of 5086 patients with open-angle glaucoma or suspected glaucoma were included, with a mean (SD) follow-up of 12.4 (4.6) years. Mean (SD) patient age was 60.5 (13.1) years, and 4468 eyes (59.9%) were from female patients. By self-reported race and ethnicity, 203 eyes (2.7%) were from Asian patients, 1718 (23.0%) from Black patients, 1677 (22.5%) from Hispanic patients, and 5536 (74.2%) from White patients. A total of 1951 eyes (26.2%) developed initial GPA likely progression; 635 eyes had adequate follow-up after first progression and IOP data. Among those, 167 (26.3%) recurred. Kaplan-Meier cumulative recurrence was 13.8% at 3 years (95% CI, 11.6%-17.1%) and 43.5% at 10 years (95% CI, 35.8%-52.1%). In multivariable Cox analysis, faster mean deviation (MD) loss before first progression (HR, 1.73 per 1 decibel [dB]/y; 95% CI, 1.39-2.15), higher mean IOP after the first event (HR, 1.09 per 1 mm Hg; 95% CI, 1.05-1.13), less negative MD at first progression (HR, 1.08 per 1 dB; 95% CI, 1.04-1.12), and older age (HR, 1.11 per 5 years; 95% CI, 1.03-1.19) were independently associated with recurrence. Each 10% greater IOP reduction was associated with lower hazard (HR, 0.89; 95% CI, 0.83-0.94). Among eyes with pre-event MD slopes faster than -1.0 dB/y, recurrence occurred in 42.7% of eyes vs 23.4% in slower-progressing eyes (difference, 19.3%; 95% CI, 8.8%-29.9%). Conclusions and Relevance: Findings from this cohort study suggest that recurrent visual field progression after a first GPA progression event is common; eyes at highest risk had faster pre-event visual field loss, less advanced damage at first progression, higher postevent IOP, and older age. These results may help target intensified monitoring and IOP lowering toward higher-risk eyes.
Source: JAMA Ophthalmology
Institution: University of Miami
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7223238325