Cumulative rates of a second vision loss event climb from 13.8% at three years to 43.5% by 10 years, as recurrent visual field progression strikes more than a quarter of glaucoma patients following an initial worsening event, according to a cohort study published in JAMA Ophthalmology. Researchers tracking records from the Bascom Palmer Eye Institute found these figures.
Bascom Palmer Registry Tracks Glaucoma Progression Rates
The cohort study drew on electronic health records from the Bascom Palmer Ophthalmic Registry, following patients receiving routine ophthalmic care between 1998 and 2025.
Investigators tracked visual field changes using Guided Progression Analysis (GPA), a software tool on the Humphrey Field Analyzer that detects worsening at identical test locations across consecutive visits.
Among 7,457 eyes monitored for an average of more than 12 years, 26.2% suffered an initial GPA progression event. Out of 635 eyes with enough follow-up data to evaluate subsequent outcomes, 26.3% experienced a second progression event, with an average interval of about 3.2 years between the first and second episodes.
Clinical Variables Predict Recurrent Vision Loss
Several distinct clinical variables independently raised the odds of recurrence: a faster rate of vision loss before the initial event, less advanced visual field damage at that first milestone, higher intraocular pressure afterward, and older age.
Specifically, each additional decibel per year of pre-event vision loss correlated with a 73% increase in relative risk for future progression—indeed, cupping does beget cupping,
as noted in an invited commentary by Tony Realini, MD.
By contrast, every 10% greater reduction in eye pressure following the first event lowered the risk of recurrence. This dynamic appeared sharply within a subgroup of 96 fast-progressing eyes that had been losing vision at a rate exceeding one decibel per year prior to their initial event. Nearly 43% of those rapid progressors went on to progress again, compared with roughly 23% of slower-progressing eyes.
While the pre-event rate of vision loss was nearly identical between those who recurred and those who did not, their pressure responses diverged: eyes avoiding a second event achieved a larger, more sustained drop in intraocular pressure, with over a third reaching a reduction of 20% or more, contrasted with just 12% of eyes that continued to worsen.
These findings suggest that recurrent progression is common after a first progression event and that intraocular pressure lowering may help protect eyes at greatest risk,
the researchers wrote in their paper on the study.
Therapy Limits Point to Future Monitoring
Despite the clear value of pressure reduction, clinicians must account for the limitations of current therapies. Dr. Realini noted that each additional millimeter of mercury of eye pressure after the first event tied to roughly a 10% higher recurrence risk, while emphasizing that IOP may not be all that matters, however, as some eyes continued to have progression despite attainment of low IOP.
Because some patients continue to worsen even when intraocular pressure falls into the low-to-mid teens, researchers suggest that pressure control alone may be insufficient, pointing toward a potential role for complementary neuroprotective strategies.
The findings collectively suggest that clinicians should treat any initial progression as a milestone requiring intensified monitoring and targeted pressure lowering, particularly for older patients and those exhibiting rapid pre-event visual field loss.
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