# From Velocity to Acceleration: A Perspective on Age-Related Visual Field Progression in Glaucoma

## TL;DR

This paper argues that measuring visual field decline in glaucoma should include acceleration, not just rate, to better predict progression in older patients.

## Contribution

The paper introduces the concept of incorporating acceleration into visual field progression assessments for glaucoma.

## Key findings

- VF sensitivity decline is inherently nonlinear with age, as shown by a cubic model for healthy eyes.
- A quadratic model captures the interaction between disease duration and baseline age in glaucomatous eyes.
- Progression accelerates over time, suggesting treatment should consider acceleration based on age and disease course.

## Abstract

The conventional evaluation of visual field (VF) progression in glaucoma often relies on linear regression to estimate the rate of decline, focusing on velocity (dB/year). However, this approach may underestimate future progression, particularly in elderly patients. This editorial highlights the importance of incorporating acceleration (dB/year²) into clinical assessments of VF loss. Using physiological and pathological models, we demonstrate that VF sensitivity decline is inherently nonlinear with age. A cubic model illustrates age-related sensitivity loss in healthy eyes, while a quadratic model captures the interaction between disease duration and baseline age in glaucomatous eyes. These models emphasize that progression accelerates over time and suggest that individualized treatment intensity should consider not only the current rate of VF decline but also its likely acceleration based on patient age and disease course.