Visual Field Progression in Glaucoma During COVID-19.

Precis: Visual fields in glaucoma significantly progressed during the COVID-19 pandemic, likely due to reduced compliance and lack of availability of medication.

Purpose: To study the impact of the COVID-19 pandemic on the rate of visual field progression in glaucoma and to validate the factors affecting progression.

Methods: This hospital based prospective cohort study included patients diagnosed with primary open angle glaucoma, primary angle closure glaucoma and ocular hypertension who fulfilled the eligibility criteria. We included 234 eyes with at least five reliable Humphrey visual fields (24-2 SITA Standard) before 24th March 2020 and two or more after. Glaucoma Progression Analysis software was used to carry out both trend and event-based analysis. Rates of progression pre and post pandemic were compared. Univariate and Multivariate logistic regression analysis were done to identify factors affecting progression.

Results: Rate of visual field progression increased significantly post lockdown, Mean Deviation(MD) pre lockdown -0.1(SD:0.8) (95% CI: -0.196, 0.001) dB/year versus -0.3(SD:0.6) (95% CI: -0.362, -0.208) dB/year post lockdown (P<0.001) and Visual Field Index(VFI) pre lockdown -0.001(SD:0.007) (95% CI: -0.002, 0) %/year versus -0.6(SD:2.2) (95% CI: -0.903, -0.342) %/year post lockdown (P<0.001). According to either trend or event analysis, of 234 eyes, 45.3% progressed and 37.6% progressed on any progression post COVID. The MD of the last field pre COVID was significantly affecting progression post COVID based on both trend and event analysis or any progression (P<0.001).

Conclusion: In patients with glaucoma on follow up, higher rates and proportions of visual field progression were found post the COVID-19 pandemic compared to pre pandemic.