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

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

Abstract:

Background/Aims: To evaluate the rate and determinants of visual field (VF) progression across different severities of primary angle-closure glaucoma (PACG).

Methods: PACG patients with ≥5 reliable VFs and ≥5 years of follow-up were included in this retrospective study. 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).

Results: 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).

Conclusions: 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.

Biography:

Shayne S Tan, Currently pursuing my love for Ophthalmology at the Singapore National Eye Centre by day and gym rat by night. An avid researcher since my medical school days, I am well published in peer review journals, and won the SingHealth Medical Student Talent Development in 2017, and was also the semi-finalist of Asia ARVO Translational Medicine Award 2017. I won the SNEC-Health Research Endowment Fund grant of SGD30,000 in 2022 for my research on choroidal perfusion in retinal vein occlusions. I was also invited speaker at the 2023 APVRS in Hong Kong. I also won the SingHealth Outstanding Resident Award in 2023, and Singapore Health Quality Services Award in 2024. I won the Singapore Society of Ophthalmology Best Oral Presentation Award Runner Up in 2024, the ESCRS 2024 Travel Bursary Award, and Best Study at the International Research Day 2024 in Taiwan. I won the SingHealth Foundation Grant again in Aug 2025 for my work on the use of oral ibuprofen and mitomycin C in improving the survival of glaucoma drainage devices, and won the SingHealth Overseas Education Mission Grant in Sept 2025 for my mission work in Laos. With a passion for drug delivery and device development, I have obtained 3 different certifications of achievement and excellence from the Harvard Medical School and Massachusetts Institute of Technology in Drug Delivery and Gene Therapy from 2023-2024, and I regularly perform animal work experiments at the Singapore Eye Research Institute. An ex-National shuttler with >10 years on the Singapore National Badminton squad, I still play badminton in my free time. You might find me on a hike with my dog on the weekends, playing the piano, or curled up in bed with a good book.