Portsmouth visual field database: an audit of glaucoma progression

Aim To explore visual field (VF) progression in a cohort of secondary care-treated glaucoma and ocular hypertensive (OHT) patients. Methods We extracted VFs from our database drawn from our normal clinical practice. VF series from 4177 eyes from 2208 patients who had five or more VFs were obtained, the ‘better’ eye was selected and the rate of VF progression was calculated using mean deviation (MD) data. Results The median rate of progression for the whole sample was −0.1 dB/year (interquartile range (IQR) −4 to 0 dB/year) over a median of 6.7 years (IQR 4.9–8.7). Of 2208 patients, 477 (21.2%) progressed at >−0.5 dB/year; 46 (2.1%) progressed at >−2.0 dB/year. Of those with a ‘final MD’ of worse than −10 dB ( N =244) in their better eye; 14.0% were ‘fast progressors’ (>−2 dB/year), 33.7% ‘moderate progressors’ (−1 to −2 dB/year), and 28.8% ‘slow progressors’ (−0.3 dB to −1 dB/year). Of those with ‘initial MD’ better than −3 dB and those with worse than −3 dB, 31/1679 (1.8%) and 213/529 (40.3%) respectively, had a final MD of worse than −10 dB. Conclusion Fast progressors, while important, are relatively rare. Moderate and slow progressors make up the majority of the progressing population within this data set. The risk of significant visual loss is much higher in those with initial damage. With increasing life expectancy, moderate and slow progressors may become increasingly clinically important.