Fellow eye prognosis in patients with severe visual field loss in 1 eye from chronic open-angle glaucoma

Objectives: To examine the prognosis for the fellow eye of patients with se vere visual field loss in 1 eye from chronic forms of open-angle glaucoma, and to identify risk factors for visual field progression in such eyes. Methods: Review of 36 patients followed in an academic medical center with monocular severe visual field loss (Advanced Glaucoma Intervention Study sc ore greater than or equal to 12) from open-angle glaucoma either at initial Humphrey visual field testing or during follow-up. Change in Advanced Glau coma Intervention Study visual field score and clinical evaluation were use d to determine visual field progression. Kaplan-Meier survival analysis and Cox proportional hazards survival regression were used to estimate visual field progression in fellow eyes and assess possible risk factors. Results: During 67 +/- 32 months (mean +/- SD), 12 of 36 first-affected eye s (33%) and 6 fellow eyes (17%) had significant visual field progression. T he Kaplan-Meier estimate of visual field progression in the fellow eye was 12.4% at 5 years after severe visual field loss in the first eye. Compared with stable fellow eyes, fellow eyes with visual field progression had sign ificantly larger initial cup-disc ratio, smaller between-eyes difference in the initial Advanced Glaucoma Intervention Study score, and lower calculat ed ocular perfusion pressure. Ocular perfusion pressure was the only variab le significantly associated with visual held progression by Cox proportiona l hazards survival regression (P = .019). During an average of 10.2 years o f disease, 2 patients (6%) became bilaterally blind from glaucoma. Conclusions: In this predominantly white population, fellow eyes of patient s with severe visual field loss in 1 eye from open-angle glaucoma were not at particularly high risk for further visual field progression, and few pat ients became bilaterally blind. Fellow eye visual field progression was ass ociated with lower calculated ocular perfusion pressure.