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Original Investigation |

Effect of Cataract Extraction on the Visual Field Decay Rate in Patients With Glaucoma ONLINE FIRST

Ji-Woong Lee, MD, PhD1,2; Esteban Morales, MS1; Fei Yu, PhD1,3; Abdelmonem A. Afifi, PhD3; Eun-Ah Kim, MD1; Niloufar Abdollahi, BS1; Kouros Nouri-Mahdavi, MD, MSc1; Joseph Caprioli, MD1
[+] Author Affiliations
1Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California
2Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
3Department of Biostatistics, Jonathan and Karin Fielding School of Public Health at the University of California, Los Angeles
JAMA Ophthalmol. Published online July 31, 2014. doi:10.1001/jamaophthalmol.2014.2326
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Importance  A visual field parameter that is resistant to cataract formation and extraction would help monitor glaucomatous visual field progression in patients with coexisting glaucoma and cataract.

Objective  To evaluate the effect of cataract surgery on the slow and fast components of visual field decay in a group of patients with glaucoma.

Design, Setting, and Participants  Retrospective, interventional, longitudinal study. Eighty-five eyes of 68 patients with open-angle glaucoma who had cataract extraction were included. All patients had 5 or more reliable visual field measurements before and after surgery.

Interventions  A pointwise exponential regression was used to perform trend analysis on thresholds at visual field test locations before and after cataract surgery. The test locations were ranked according to the decay rate and were partitioned into slow and fast groups.

Main Outcomes and Measures  The slow and fast visual field rate components were measured before and after cataract surgery and were compared. Linear regressions of the mean deviation and the visual field parameter were performed against time and were compared before and after surgery.

Results  The mean (SD) mean deviation was −5.5 (5.1) dB before cataract surgery and −5.0 (4.9) dB after cataract surgery (P = .002). The mean (SD) Visual Field Index was 86.4% (13.5%) before cataract surgery and 86.6% (13.3%) after cataract surgery (P = .30). The mean (SD) slow component rate decreased from 0.48% (0.73%) per year before surgery to 0.26% (0.42%) per year after surgery (P = .04). No statistically significant difference was identified in the fast component mean (SD) rate per year before surgery (3.37% [4.05%]) vs per year after surgery (3.46% [3.56%]) (P = .29).

Conclusions and Relevance  Cataract progression seems to be the main determinant for the slow visual field rate component and does not change the fast visual field rate component. We conclude that the method used can help reduce the confounding effects of cataract progression and cataract extraction on measured perimetric progression in glaucoma.

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Figure.
Frequency Distributions Comparing the Visual Field Decay Rates Before and After Cataract Surgery

A shift of the postoperative graphs to the left for the slow component indicates a slowing down of the progression rate after surgery. No statistically significant difference was identified in the visual field decay rate for the fast component or the regression slopes for the mean deviation (MD) and the Visual Field Index (VFI).

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