Visual field progression in varying severities of treated patients with primary angle closure glaucoma

To evaluate the rate and determinants of visual field (VF) progression across different severities of primary angle-closure glaucoma (PACG). Chinese patients with PACG who had ≥ 5 reliable VFs and ≥ 5 years of follow-up were included. Disease severity was classified by baseline mean deviation (MD) as mild (≥-6.0dB), moderate (-6.01 to -12.0dB) or severe (<-12.0dB). VF progression was categorized as slow (>-0.25dB/year), intermediate (-0.25 to -1.0dB/year), or fast (≤-1.0dB/year). Among 783 patients evaluated, 477 met the inclusion criteria: 140 (29.4%) mild, 161 (33.8%) moderate, and 176 (36.9%) severe PACG. Most eyes showed slow progression (n = 248, 52.0%), followed by intermediate (n = 164, 34.4%) and fast (n = 65, 13.6%). Moderate PACG progressed fastest (-0.45 ± 0.80dB/year), compared with mild (-0.39 ± 0.54dB/year) and severe disease (-0.12 ± 1.12dB/year) (p < 0.001), demonstrating a U-shaped relationship between disease severity and progression. In mild PACG, a longer interval to cataract surgery was associated with reduced odds of slow progression (OR, 0.90; 95% CI, 0.81-1.00, p = 0.05). In moderate PACG eyes, females and poorer presenting visual acuity were associated with slow progression (OR, 3.12; 95% CI, 1.33–7.72; p = 0.01 and OR, 5.54; 95% CI, 1.37–26.50; p = 0.02 respectively). In severe PACG, females and higher presenting IOP were associated with slow progression (OR, 2.63; 95% CI, 1.20–5.97; p = 0.02 and OR, 1.06; 95% CI, 1.01–1.11; p = 0.02 respectively). VF progression in PACG patients demonstrated a U-shaped relationship with disease severity, with moderate PACG exhibiting the fastest progression. Determinants of progression differed for different severities of PACG, highlighting the importance of stage-specific treatment of PACG.