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 severe 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 score > or =12) from open-angle glaucoma either at initial Humphrey visual field testing or during follow-up. Change in Advanced Glaucoma Intervention Study visual field score and clinical evaluation were used 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 eyes (33%) and 6 fellow eyes (17%) had significant visual field progression. The 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 significantly larger initial cupdisc ratio, smaller between-eyes difference in the initial Advanced Glaucoma Intervention Study score, and lower calculated ocular perfusion pressure. Ocular perfusion pressure was the only variable significantly associated with visual field progression by Cox proportional hazards survival regression (P = .019). During an average of 10.2 years of disease, 2 patients (6%) became bilaterally blind from glaucoma. CONCLUSIONS In this predominantly white population, fellow eyes of patients 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 patients became bilaterally blind. Fellow eye visual field progression was associated with lower calculated ocular perfusion pressure.