Visual Field Loss in Normal-tension Glaucoma Patients
Visual Field Loss in Normal-tension Glaucoma Patients
Purpose: To investigate the prognostic factors responsible for the progression of visual field defects (VFDs) in patients with normal-tension glaucoma (NTG) treated with topical antiglaucoma medications.
Patients and Methods: A total of 92 eyes in 92 NTG patients treated with only topical antiglaucoma medications for ≥5 years were retrospectively analyzed. To identify subfield-based prognostic factors, the central 30-degree visual field (Humphrey Field Analyzer) was divided into 6 subfields: upper and lower arcuate, paracentral, and cecocentral subfields. Factors related to subfield-based progression (age, refraction, mean intraocular pressure (IOP), IOP variability, central corneal thickness, and disc hemorrhage) were evaluated using a linear mixed model.
Results: Ninety-two eyes in 92 NTG patients were included in this study. The mean observation period was 7.7±2.7 (5.0 to 15.5) years, and the estimated rate of change in the mean deviation value was -0.16±0.31 dB/y (P<0.001). A subfield-based linear mixed model analysis of the time course of changes in the mean of total deviation identified a greater extent of myopia as a significant positive prognostic factor for VFD progression in the upper paracentral area (P=0.016). The mean IOP, central corneal thickness, disc hemorrhage, age, and IOP variation showed no significant contribution in any of the subfields.
Conclusions: The extent of myopia was found to be a significant positive prognostic factor for VFD progression in the upper paracentral subfield for non–high-myopic NTG eyes with an average IOP of 14.2 mm Hg under topical antiglaucoma medication.
Glaucoma patients require long-term treatment. More aggressive ocular hypotensive therapy may be indicated in patients with an advanced visual field defect (VFD) that threatens vision-related quality of life, with coexisting negative prognostic factors such as pseudoexfoliation, disc hemorrhage (DH), age, myopia, reduced central corneal thickness (CCT), or with sufficiently high untreated intraocular pressure (IOP). In contrast, many patients with open angle glaucoma (OAG), especially those without high IOP, are medically managed and followed up on a long-term basis, as long as IOP is maintained around or below the normal average level. Although visual field (VF) loss is expected to progress relatively slowly, it is still clinically important to identify patients who may show more rapid progression, especially those with advanced damage, and to define factors that contribute to rapid progression. The progression of VF loss shows intersubfield variation. For example, the superior arcuate or paracentral subfield is more likely to be damaged at the early stages, and the lower cecocentral subfield is more likely to be spared until later stages. In addition, previous studies have shown that the modalities of VF loss are not always correlated between the upper and lower hemifields. It has also been reported that the pattern of VF loss is influenced by IOP and refraction.11,16–22
From the viewpoint of vision quality, maintenance of the central subfield is clinically more important than maintenance of the peripheral VF. To date, however, VF prognostic factors have been studied with respect to the whole VF. To identify subfield-based prognostic factors in medically treated normal-tension glaucoma (NTG) patients, we divided the central 30-degree VF into 6 subfields: the upper and lower arcuate, paracentral, and cecocentral subfields. Subfield-based progression of VF loss and its related factors were retrospectively analyzed in NTG patients who received topical antiglaucoma medication and could be followed up for ≥5 years.
Abstract and Introduction
Abstract
Purpose: To investigate the prognostic factors responsible for the progression of visual field defects (VFDs) in patients with normal-tension glaucoma (NTG) treated with topical antiglaucoma medications.
Patients and Methods: A total of 92 eyes in 92 NTG patients treated with only topical antiglaucoma medications for ≥5 years were retrospectively analyzed. To identify subfield-based prognostic factors, the central 30-degree visual field (Humphrey Field Analyzer) was divided into 6 subfields: upper and lower arcuate, paracentral, and cecocentral subfields. Factors related to subfield-based progression (age, refraction, mean intraocular pressure (IOP), IOP variability, central corneal thickness, and disc hemorrhage) were evaluated using a linear mixed model.
Results: Ninety-two eyes in 92 NTG patients were included in this study. The mean observation period was 7.7±2.7 (5.0 to 15.5) years, and the estimated rate of change in the mean deviation value was -0.16±0.31 dB/y (P<0.001). A subfield-based linear mixed model analysis of the time course of changes in the mean of total deviation identified a greater extent of myopia as a significant positive prognostic factor for VFD progression in the upper paracentral area (P=0.016). The mean IOP, central corneal thickness, disc hemorrhage, age, and IOP variation showed no significant contribution in any of the subfields.
Conclusions: The extent of myopia was found to be a significant positive prognostic factor for VFD progression in the upper paracentral subfield for non–high-myopic NTG eyes with an average IOP of 14.2 mm Hg under topical antiglaucoma medication.
Introduction
Glaucoma patients require long-term treatment. More aggressive ocular hypotensive therapy may be indicated in patients with an advanced visual field defect (VFD) that threatens vision-related quality of life, with coexisting negative prognostic factors such as pseudoexfoliation, disc hemorrhage (DH), age, myopia, reduced central corneal thickness (CCT), or with sufficiently high untreated intraocular pressure (IOP). In contrast, many patients with open angle glaucoma (OAG), especially those without high IOP, are medically managed and followed up on a long-term basis, as long as IOP is maintained around or below the normal average level. Although visual field (VF) loss is expected to progress relatively slowly, it is still clinically important to identify patients who may show more rapid progression, especially those with advanced damage, and to define factors that contribute to rapid progression. The progression of VF loss shows intersubfield variation. For example, the superior arcuate or paracentral subfield is more likely to be damaged at the early stages, and the lower cecocentral subfield is more likely to be spared until later stages. In addition, previous studies have shown that the modalities of VF loss are not always correlated between the upper and lower hemifields. It has also been reported that the pattern of VF loss is influenced by IOP and refraction.11,16–22
From the viewpoint of vision quality, maintenance of the central subfield is clinically more important than maintenance of the peripheral VF. To date, however, VF prognostic factors have been studied with respect to the whole VF. To identify subfield-based prognostic factors in medically treated normal-tension glaucoma (NTG) patients, we divided the central 30-degree VF into 6 subfields: the upper and lower arcuate, paracentral, and cecocentral subfields. Subfield-based progression of VF loss and its related factors were retrospectively analyzed in NTG patients who received topical antiglaucoma medication and could be followed up for ≥5 years.
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