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The following is a summary of “A retrospective evaluation of the clinical monitoring period prior to referral for glaucoma surgery with the emphasis on visual field test results,” published in the March 2025 issue of BMC Ophthalmology by Hougaard et al.  

Researchers conducted a retrospective study to analyze the monitoring of individuals who underwent glaucoma surgery and identify routines that may have delayed the referral process.  

They analyzed a two-year period before referral for individuals who underwent trabeculectomy or Xen® Gel Stent implantation at Skåne University Hospital (SUS), Sweden. Medical records provided the data, with a focus on intraocular pressure (IOP) measurements and visual field (VF) tests.  

The results showed that out of 330 individuals who underwent surgery, 139 were included. Among 20 referring clinics, SUS and 2 private clinics accounted for 55.4% of referrals. Before referral, the most common number of VF tests per individual was 3, and 43.2% (60/139) had ≥ 10 IOP measurements. The last VF test indicated that 51.1% had lost > 50% of a full VF, and during the 2-year period, 21.9% (28/128 with ≥ 2 VF tests) progressed from ≥ 50% to < 50% remaining. In 107 individuals with ≥ 3 VF tests, the median rate of VF damage progression was -6.8% per year, and 67.3% (72/107) were projected to lose > 50% of a full VF if referral had been delayed by 2 years. At the last IOP measurement before referral, 84% (117/139) were using ≥ 3 IOP-lowering agents, and IOP ranged from 11–45 mmHg, with a median of 20 mmHg.  

Investigators concluded that excessive IOP monitoring, despite seemingly adequate VF testing, likely delayed necessary surgical referrals for patients with advanced glaucoma and rapid vision loss. 

Source: bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-025-03925-z