Focusing on glaucoma progression and the clinical importance of progression rate measurement: a review L Rossetti, F Goni, P Denis, B Bengtsson, A Martinez and A Heijl Abstract Purpose This review aims to provide guidance in managing glaucoma patients more effectively. It focuses on the importance of detecting progression and measuring its rate within the management of primary open-angle glaucoma today. Recent findings strongly indicate that continued monitoring of visual fields (VFs) and reassessment of target intraocular pressures (IOPs) depending on VF progression rates are mandatory in the management of glaucoma. Methods Data on glaucoma progression from older as well as most recent literature findings are summarized in this article. In addition, the article elaborates on the scientific content from a series of lectures given by experts in the field during several international symposia on ‘rate of progression’ in 2008. Results This review summarizes key findings on the natural history of glaucoma and known factors for disease progression. It highlights the visual function changes observed as glaucoma progresses and discusses disease impact on patients’ quality of life. Findings support the need to obtain information on rate of progression and its importance for clinical management. Practical ways to measure rate of progression are given by new software options to help measure major parameters. Finally, on the basis of a patient’s individual rate of progression therapeutic options are assessed, such as maximum medical therapy with fixed combinations. Conclusions Estimating a patient’s individual rate of VF progression by using newly developed analyses will be helpful to forecast the potential future development of the glaucoma. An individualized treatment approach then requires that in patients in whom the risk of becoming visually impaired or blind during their lifetime is higher, a more intensive medical IOP-lowering therapy such as fixed combinations can be considered as treatment option. Eye (2010) 24, S1–S7; doi:10.1038/eye.2010.112 Keywords: glaucoma; progression; rate of progression; visual fields; perimetry; target pressure Introduction The number of people with visual impairment in 2002 was more than 161 million worldwide, of whom about 37 million were bilaterally blind. After cataract glaucoma is found to be the second leading cause of blindness. 1 The impact of glaucoma on health-care systems is currently increasing with ageing population. In the Western world chronic open-angle glaucoma (OAG) is by far the most common form of the disease. Disease progression in glaucoma is not uncommon and despite treatment, most patients still progress. A retrospective community-based longitudinal study from Olmsted County in the United States reviewed charts of 295 OAG patients for a mean follow- up time of 15 years to determine the probability of a patient developing ‘legal blindness’ in either one or both eyes from newly diagnosed OAG after starting medical or surgical therapy Department of Ophthalmology, University Hospital, Lund University, Malmo ¨ , Sweden Correspondence: A Heijl, Department of Ophthalmology, University Hospital, Lund University, SE-20502 Malmo ¨ , Sweden. Tel: þ 46 40 332742; Fax: þ 46 40 924221 E-mail: Anders.Heijl@ med.lu.se Eye (2010) 24, S1–S7 & 2010 Macmillan Publishers Limited All rights reserved 0950-222X/10 $32.00 www.nature.com/eye REVIEW