Visual field progression in Asian glaucoma patients: a 10-year stratified cohort analysis from a national health system with universal coverage

Abstract

Purpose: To investigate visual field (VF) progression patterns in an Asian population with glaucoma and assess how age, disease severity, and a universal health coverage system (Taiwan's National Health Insurance, NHI) jointly influence long-term outcomes.

Methods: This 10-year retrospective study (2013-2022) at a tertiary referral center included patients with ≥ 4 reliable standard automated perimetry (SAP) tests using 24-2 and 30-2 Swedish Interactive Threshold Algorithm strategies. Patients were stratified by age (< 40, 40-65, > 65) and disease severity (mild, moderate, severe, advanced). VF progression was analyzed using linear mixed models.

Results: A total of 9,901 SAP tests from 1,841 patients (mean age: 47.17 ± 16.23 years) were analyzed. The overall VF progression rate was -0.044 ± 0.956 dB/year. The observed progression in our cohort appeared slower, which may be associated with earlier diagnosis and consistent care under NHI. However, direct comparisons with Western cohorts should be interpreted cautiously due to differences in glaucoma subtypes and patient demographics. Significant progression was seen in mild to severe cases, but not in advanced glaucoma. Patients over 65 with mild disease showed accelerated decline, suggesting an age-severity interaction.

Conclusion: As the first large-scale, decade-long study of VF progression in an Asian cohort under universal health coverage, our findings reveal a synergistic interaction between age and disease severity, with elderly patients-especially those with mild disease-facing accelerated decline. The slower progression observed under NHI suggests that equitable, accessible care may help mitigate long-term visual loss. These results underscore the importance of early detection, tailored intervention, and policy support to improve outcomes in aging glaucoma Asian populations.

Key messages: What is known Visual field (VF) progression is a critical indicator in glaucoma care and has been extensively studied in Western populations. Disease severity and aging are established risk factors for glaucoma progression. What is new This is the first large-scale, real-world longitudinal analysis of VF progression in an Asian glaucoma cohort under universal health coverage over a 10-year span. In our cohort, patients were relatively younger at diagnosis and exhibited slower VF deterioration, which may reflect the influence of Taiwan's National Health Insurance system in facilitating early detection and continuous care. Cross-population comparisons should be interpreted with caution given differences in glaucoma subtypes and demographics. Elderly patients with mild glaucoma exhibited unexpectedly rapid VF decline, suggesting a need for more aggressive early management.

Keywords: Asian; Glaucoma; National health insurance; Progression; Visual field.