Rates of Visual Field Progression Before and After the Onset of Atrial Fibrillation.

Precis: This case-control study investigated the effect of atrial fibrillation (AF) on the progression of glaucoma. The presence of AF and related microvascular damage were associated with a slightly faster visual field loss in glaucoma patients.

Purpose: To investigate the effect of atrial fibrillation (AF) on glaucoma progression.

Methods: In this longitudinal case-control study, a total of 144 eyes from 105 patients with primary open angle glaucoma were included. 48 eyes of case developed AF during the follow-up followed for 15.6 years. 96 eyes of control that did not have AF at baseline or during follow-up matched for age, baseline glaucoma severity and follow-up period were followed for an average of 14.7 years. Mixed-effects linear models were used to calculate the difference in the VF MD slopes before and after the AF. CHADS2 and CHA2DS2-VASc scores were used to evaluate the risk of thrombosis event, and related microvascular damage was assessed based on these scores.

Results: The rate of VF MD change was -0.20 (-0.42 to 0.02) dB/y before AF and -0.28 (-0.47 to -0.09) dB/y after AF for the patients with AF, and -0.21 (-0.25 to -0.17) dB/y for the control. In the multivariable models, the VF slope difference before and after the onset of AF (-0.10 (-0.14 to -0.05) dB/y, P<0.001), higher CHADS2 score (-0.07 (-0.13 to 0.00) dB/y per 1 unit, P=0.040), and higher CHA2DS2-VASc score (-0.05 (-0.10 to 0.00) dB/y per 1 unit, P=0.039) were associated with faster VF MD loss.

Conclusions: The presence of atrial fibrillation and related microvascular damage might accelerate visual field loss. This underscores the need for a comprehensive medical history and management of cardiovascular risk factors to mitigate increase VF loss in glaucoma.