To investigate the association between baseline optic nerve head prelaminar schisis and the rates of visual field mean deviation (VF MD) slopes in glaucoma.

Retrospective clinical cohort study.

This study included 563 eyes (446 with primary open-angle glaucoma and 117 glaucoma suspect eyes) from 332 patients. Two independent graders evaluated the baseline presence and severity of prelaminar schisis using optical coherence tomography radial scans. The severity was graded on a four-point ordinal scale: 0 (none), 1 (mild), 2 (moderate), and 3 (severe). The interrater reliability was assessed using weighted kappa. Two linear mixed-effect models were employed to assess the association between the presence of schisis (model 1) and schisis severity (model 2) with VF MD slopes, while adjusting for relevant demographic and ocular characteristics.

Prelaminar optic nerve head schisis was observed in 258 eyes (45.8%). Among these, grade 1 was identified in 36 eyes (14.0%), grade 2 in 181 eyes (70.2%), and grade 3 in 41 eyes (15.9%). The weighted kappa was 0.66. In multivariable models, the presence of schisis was associated with a faster VF MD slope (–0.22 dB/y; 95% confidence interval [CI]: –0.30, –0.13 P ≤ .001). Compared to eyes without prelaminar schisis (grade 0), those with schisis were associated with faster VF MD slopes. This was more significant with grade 3 (–0.40 dB/y; 95% CI: –0.63, –0.18; P < .001) than with grade 1 (–0.18 dB/y; 95% CI: –0.34, –0.03; P = .023), or grade 2 (–0.18 dB/y; 95% CI: –0.26, –0.09; P < .001). Age and baseline VF MD were also independently associated with VF progression in both models.

The presence and severity of severe prelaminar schisis were associated with faster VF progression, suggesting its potential as a biomarker to identify patients at higher risk of progression and to guide clinical management in glaucoma.