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Five-year visual field outcomes of the HORIZON trial

Montesano, G. ORCID: 0000-0002-9148-2804, Ometto, G. ORCID: 0000-0002-0900-4847, Ahmed, I. I. K. , Ramulu, P. Y., Chang, D. F., Crabb, D. P. ORCID: 0000-0001-8611-1155 & Gazzard, G. (2023). Five-year visual field outcomes of the HORIZON trial. American Journal of Ophthalmology, 251, pp. 143-155. doi: 10.1016/j.ajo.2023.02.008

Abstract

Purpose
to compare visual field (VF) progression between glaucoma patients receiving cataract surgery alone (CS) or with a Hydrus microstent (CS-HMS)

Design
post-hoc analysis of VF data from the HORIZON multicenter randomized controlled trial

Methods
556 patients with glaucoma and cataract were randomized 2:1 to either CS-HMS (369) or CS (187) and followed up for 5 years. VF was performed at 6 months and then every year after surgery. We analyzed data for all participants with at least 3 reliable VFs (false positives < 15%). Average between-group difference in rate of progression (RoP) was tested using a Bayesian mixed model and a two-sided Bayesian p-value < 0.05 (main outcome). A multivariable model measured the effect of intraocular pressure (IOP). A survival analysis compared the probability of global VF sensitivity dropping by predefined cut-offs (2.5, 3.5, 4.5 and 5.5 dB) from baseline.

Results
data from 352 eyes in the CS-HMS arm and 165 in the CS arm were analyzed (2966 VFs). The average RoP was (Estimate [95% Credible Intervals]) -0.26 [-0.36, -0.16] dB/year for CS-HMS and -0.49 [-0.63, -0.34] dB/year for CS. This difference was significant (p = 0.0138). The difference in IOP only explained 17% of the effect (p < 0.0001). Five-year survival analysis showed an increased probability of VF worsening by 5.5 dB (p = 0.0170), indicating a greater proportion of fast progressors in the CS arm.

Conclusions
CS-HMS has a significant effect on VF preservation in glaucoma patients compared to CS alone, reducing the proportion of fast progressors.

Publication Type: Article
Subjects: R Medicine > RE Ophthalmology
Departments: School of Health & Psychological Sciences > Optometry & Visual Sciences
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