Visual Field Progression in Glaucoma Patients With Delayed Follow-Up

OBJECTIVE: To query current practice for glaucoma follow-up intervals by studying the association between delayed follow-up (DFU) and glaucoma progression. DESIGN: Retrospective cohort and matched case-control study. SUBJECTS: Glaucoma patients and suspects at a tertiary care center. METHODS: Electronic health record and Humphrey Visual Field (HVF) data were collected for patients with at ≥5 HVF tests between 2014 and 2023. DFU was defined as exceeding provider-recommended intervals and quantified for each participant as the percentage of visits with DFU, mean days of DFU, and maximum days of DFU. Associations between DFU metrics and HVF progression were analyzed using covariate adjusted multivariable logistic regression models. Subgroup analyses by baseline mean deviation (MD) and a sensitivity analysis of patients with 2 or more HVF tests with case-control matching (age, follow-up duration, number of HVF tests, and baseline MD) were performed. MAIN OUTCOME MEASURES: HVF progression: MD linear regression slope ≤-0.5 dB/year across all tests. RESULTS: A total of 1121 eyes from 600 patients were included (mean follow-up: 7.3 years; mean baseline age: 73.7 years; 50.2% female). HVF progression occurred in 19.8% of eyes with baseline MD >-6 dB and 32.8% with baseline MD ≤-6 dB. Any DFU occurred in 53.4% of all visits. In multivariable analyses, percentage of visits with DFU, mean days of DFU, and maximum days of DFU were not associated with HVF progression, including in subgroup analyses. Older age, larger cup to disc ratio, shorter follow-up duration, higher number of HVF tests, and unmet social needs were associated with higher odds of HVF progression (all P < .05). In the matched case-control analysis, a mean DFU of >60 days was significantly associated with higher odds of HVF progression (aOR: 1.95; 95% CI: 1.03-3.68, compared to ≤30 days), and a maximum DFU of >365 days showed a borderline association (aOR: 1.77; 95% CI: 0.97-3.23, compared to ≤120 days) among patients with baseline MD <-6 dB. CONCLUSION: These findings suggest that longer follow-up intervals than those currently prescribed may not be associated with VF progression for most glaucoma patients.