# Visual Field Progression in Childhood Glaucoma Versus Open-Angle Glaucoma: A Retrospective Comparative Study

## TL;DR

This study compares how visual field loss progresses in childhood glaucoma and open-angle glaucoma, finding that childhood glaucoma tends to have worse initial vision but slower deterioration over time.

## Contribution

The study provides new evidence on the progression rates and timing of visual field loss in childhood glaucoma compared to open-angle glaucoma.

## Key findings

- Childhood glaucoma had a faster rate of visual field deterioration compared to open-angle glaucoma.
- Baseline mean defect was worse in childhood glaucoma, but progression-free survival was similar between the two groups.
- Baseline mean defect was the strongest predictor of final visual field status in both groups.

## Abstract

Background: Evidence on long-term visual field progression in childhood glaucoma compared with open-angle glaucoma (OAG) is limited. We compared the rate and timing of visual field progression and identified predictors of final visual field status. Methods: Single-center, retrospective, observational study including childhood glaucoma and OAG, with ≥3 reliable visual field tests and ≥2 years of follow-up. Visual fields were obtained with Octopus perimeter (Haag-Streit Diagnostics, Köniz, Switzerland) with the G grid and TOP strategy. Visual field progression was evaluated using the rate of change in mean defect (MD, dB/year). Rates were compared with the Mann–Whitney U test. Timing was evaluated with Kaplan–Meier and restricted mean survival time (RMST). Cox models assessed risk of progression. Secondary analysis used multiple linear regression to identify predictors of final MD. The mean follow-up duration was 5.7 ± 2.6 years. Results: 171 eyes (87 childhood glaucoma, 84 OAG) were analyzed. Childhood glaucoma had worse baseline MD (10.7 ± 7.5 dB) than OAG (5.1 ± 6.5 dB, p < 0.001), and underwent more surgeries, while OAG used more medications. The median MD progression rate was −2.3 dB/year [IQR: −5.6 to 0.1] in childhood glaucoma vs. 0.0 dB/year [IQR: −1.2 to 1.3] in OAG (p < 0.001), a value consistent with functional stability under treatment, with some eyes showing negative slopes indicating relative improvement. In Octopus perimetry, MD is expressed on a positive scale, so a negative slope reflects absence of visual field worsening, suggesting comparatively greater deterioration in OAG. Kaplan–Meier curves showed similar progression-free survival between groups (Log-Rank p = 0.284). RMST at 12 years was 10.93 years in childhood glaucoma and 10.56 years in OAG (difference ≈ 4.4 months, not clinically relevant). These survival results should be interpreted cautiously due to the low number of progression events and the high censoring rate. In regression, baseline MD was the strongest predictor of final MD; a higher number of medications was associated with worse final MD; number of surgeries and follow-up duration were not significant predictors. Conclusions: MD slopes suggested faster deterioration in OAG than in childhood glaucoma, whereas the timing to first progression was similar between groups. Baseline differences and treatment patterns were consistent with functional stability in childhood glaucoma under current management strategies. These findings support individualized follow-up and timely intervention, especially in pediatric patients.