Glaucoma progression: watch out the fellow, non-progressing eye

In clinical practice, the detection of visual field progression in one eye usually leads to management modifications in that eye. Less attention is paid to contralateral eyes where visual field remains apparently stable on follow-up. Non-progressing eyes may show significant structural changes despite of any noticeable visual field worsening (1,2).

Evidence has shown that a documented structural change represents a risk factor for visual field progression (3,4). Hence, the detection of visual field progression in one eye demands a careful evaluation of the fellow eye, in terms of structural change, as measured more frequently with OCT.

Contributor: Francisco Goni, Spain

References

1. Liu T, Tatham AJ, Gracitelli CPB, Zangwill LM, Weinreb RN, Medeiros FA. Rates of Retinal Nerve Fiber Layer Loss in Contralateral Eyes of Glaucoma Patients With Unilateral Progression by Conventional Methods. Ophthalmology 2015. Nov;122(11):2243-51.
2. Demirel S, De Moraes CGV, Gardiner SK, Liebmann JM, Cioffi GA, Ritch R, Gordon MO, Kass MA and for the Ocular Hypertension Treatment Study. The Rate of Visual Field Change in the Ocular Hypertension Treatment Study. Invest Ophthalmol Vis Sci. 2012 Jan; 53(1): 224–227.
3. Miki A, Medeiros FA, Weinreb RN, Jain S, He F, Sharpsten L, Khachatryan N, Hammel N, Liebmann JM, Girkin CA, Sample PA, Zangwill LM. Rates of Retinal Nerve Fiber Layer Thinning in Glaucoma Suspect Eyes. Ophthalmology 2014. Jul;121(7):1350-8.
4. Yu M, Lin C, Weinreb RN, Lai G, Chiu V, Leung CK-S. Risk of Visual Field Progression in Glaucoma Patients With Progressive Retinal Nerve Fiber Layer Thinning: A 5-Year Prospective Study. Ophthalmology 2016. Jun;123(6):1201-10.

Tip Reviewer: Roger Hitchings
Tip Editors: Frances Meier-Gibbons, Humma Shahid, Karl Mercieca, Francisco Goni