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

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.