<p>To identify risk factors associated with visual field progression over long-term follow-up (10 years) in patients newly diagnosed with exfoliation glaucoma. This was a non-randomised, prospective cohort study including patients newly diagnosed with exfoliation glaucoma. Visual field progression was assessed using three methods mean deviation (MD), visual field index (VFI), and guided progression analysis (GPA). Baseline variables to be evaluated included intraocular pressure (IOP), sex, age, visual fields, uni- or bilateral presentation, visual acuity, lens status (phakic/pseudophakic), central corneal thickness (CCT), optic nerve status, and gonioscopy findings. Additionally, a questionnaire on, hypertension, diabetes, migraine, smoking, and family history of glaucoma. Multivariable regression analyses were performed to identify risk factors. A total of 58 patients completed the 10-year follow-up. The IOP at inclusion was 32.06 (± 6.05) mmHg. In the MD model, significant risk factors for progression included older age (<i>p</i> = 0.002), smoking (<i>p</i> = 0.004), phakic lens status (<i>p</i> &lt; 0.001), and lower CCT (<i>p</i> = 0.02). In the VFI model, significant risk factors were older age (<i>p</i> = 0.009) and smoking (<i>p</i> = 0.04). In the GPA model, risk factors included older age (<i>p</i> = 0.001) and smoking (<i>p</i> = 0.01). Older age at diagnosis and a history of smoking were found to be significantly associated with an increased risk of long-term visual field progression.</p>