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PURPOSE: To evaluate racial differences in the development of visual field (VF) damage in glaucoma suspects. DESIGN: Prospective, observational cohort study. METHODS: Six hundred thirty-six eyes from 357 glaucoma suspects with normal VF at baseline were included from the multicenter African Descent and Glaucoma Evaluation Study (ADAGES). Racial differences in the development of VF damage were examined using multivariable Cox proportional hazard models. RESULTS: Thirty one of 122 African-descent participants (25.4%) and 47 of 235 European-descent participants (20.0%) developed VF damage (P = .078). In multivariable analysis, worse baseline VF mean deviation, higher mean arterial pressure during follow-up, and a race * mean intraocular pressure (IOP) interaction term were significantly associated with the development of VF damage, suggesting that racial differences in the risk of VF damage varied by IOP. At higher mean IOP levels, race was predictive of the development of VF damage even after adjusting for potentially confounding factors. At mean IOPs during follow-up of 22, 24, and 26 mm Hg, multivariable hazard ratios (95% confidence intervals) for the development of VF damage in African-descent compared to European-descent subjects were 2.03 (1.15-3.57), 2.71 (1.39-5.29), and 3.61 (1.61-8.08), respectively. However, at lower mean IOP levels (below 22 mm Hg) during follow-up, African descent was not predictive of the development of VF damage. CONCLUSION: In this cohort of glaucoma suspects with similar access to treatment, multivariate analysis revealed that at higher mean IOP during follow-up, individuals of African descent were more likely to develop VF damage than individuals of European descent. [ABSTRACT FROM AUTHOR]