PURPOSE. To explore the correlation between longitudinal changes of peripapillary retinal nerve fiber layer (RNFL) thickness and the presence of parapapillary choroidal microvasculature dropout (MvD). METHODS. This is a longitudinal cohort study. All patients with normal-tension glaucoma (NTG) were recruited from the Wenzhou Glaucoma Progression Study. The presence of MvD was determined using optical coherence tomography (OCT) angiography and the RNFL thickness was evaluated by spectral-domain OCT. All assessments were performed both at baseline and at every 3-month follow-up for at least 18 months. RESULTS. Seventy-one eyes were included. The presence of MvD was observed in 23 NTG eyes (32.4%). Eyes with MvD had a thinner RNFL (68.8 6 9.6 vs. 76.2 6 16.7 lm, P ¼ 0.016) and a faster rate of RNFL loss (À1.2 6 1.5 vs. À0.4 6 1.4 lm/y, P ¼ 0.036) compared with those without MvD. In a univariate analysis of rates of RNFL loss, the presence of MvD at baseline (b ¼ À0.83 6 0.38, P ¼ 0.033) was significantly associated with progressive RNFL loss. After adjusting for age, female sex, mean follow-up IOP, axial length, central corneal thickness, and mean deviation, the presence of MvD at baseline (b ¼ À0.85 6 0.41, P ¼ 0.041) was significantly associated with faster rates of RNFL loss in the multivariate analysis. CONCLUSIONS. There is a significant correlation between the presence of MvD and decrease in RNFL thickness in NTG patients. Our study further supported that the presence of MvD is a predictor of longitudinal RNFL damage in glaucoma.

Background: Exercise is widely known to lower intraocular pressure and increase ocular blood flow, which may be beneficial for glaucoma management. However, there are few studies that have reported on the relationship between exercise and glaucoma progression. The aim of our study was to investigate the exercise habits of those with primary open angle glaucoma (POAG) and its association with the progression of visual field (VF) loss. Methods: Daily physical activity (PA) was monitored by an accelerometer (ActiGraph wGT3x-BT) which patients wore for more than 10 h of being awake on their right wrists for 1 week. Results: Seventy-one non-progressive and 27 progressive patients were enrolled in the study. 24-h moderate to vigorous physical activity (MVPA) exercise showed that POAG patients had similar variation trends consisting of 3 wave peaks and 2 wave hollows. Minutes spent in

Background: To investigate the association between lateral decubitus sleeping position (LDSP) and asymmetric visual field (VF) loss and progression in primary open-angle glaucoma (POAG) patients. Methods: This was a prospective, cohort study. Sixty-eight POAG (53 normal tension glaucoma, NTG) patients with asymmetric VF loss were included from the Wenzhou Glaucoma Screening Program (WGSP) and followed up. A questionnaire was used to determine the LDSP. Asymmetric VF loss was defined as at least 2-dB difference in mean deviation (MD) between the 2 eyes at baseline. According to these values, the better eye and worse eye were defined. The number of those preferring the worse eye LDSP versus the better eye LDSP was compared. The number of progressive eyes with LDSP and fellow eyes of LDSP were also compared. Results: Forty-five (66.2%) POAG and 34 (64.2%) NTG patients preferred the LDSP. Of these, 24 (53.3%, p=0.66) and 16 (47.1%, p=0.73) preferred the worse eye LDSP, respectively. Twenty-six eyes of the 45 POAG patients with both asymmetric VF loss and LDSP were judged as progression until the last follow-up (24.7 ± 9.5 months). Among which, there were 12 (46.2%) eyes with LDSP and 14 (53.8%) fellow eyes of LDSP (p=0.70). Conclusions: Approximately two thirds of the POAG/NTG patients preferred the LDSP. However, we could not draw the conclusion that lateral decubitus sleeping position is associated with asymmetric VF loss or glaucoma progression. Keywords: primary open-angle glaucoma; normal tension glaucoma; preferred sleeping position; asymmetric visual field defect

Purpose: To characterize and compare the longitudinal change of macular vessel density (VD) in primary open angle glaucoma (POAG) eyes across different disease stages. Methods: This is a sub-analysis of a prospective cohort study. A total of 103 eyes (53 eyes in the mild stage, 50 eyes in the moderate-to-advanced stage) of 75 POAG patients followed for more than 1 year with at least 2 qualified optical coherence tomography (OCT) angiography (OCTA) images were included. The rates of macular VD change were determined by linear regression and compared using the generalized linear mixed models between groups. Mixed effect models were used to evaluate the demographic and ocular parameters associated with the VD loss rate. Results: With a mean follow-up time of 2.36 years, the rates of macular VD change were significantly different from zero in both groups. The rates of macular VD loss were significantly faster in moderate-to-advanced stage group than in mild stage group in whole image (-2.46%/yr vs -1.47%/yr, p=0.002), superior hemifield (-2.42%/yr vs -1.30%/yr, p=0.001), para fovea (-2.35%/yr vs -1.26, p=0.001), superior (-2.20%/yr vs -1.01%/yr, p=0.002), nasal (-2.41%/yr vs -1.04%/yr p=0.001), inferior (-2.46%/yr vs -1.43%/yr, p=0.018) and temporal sectors (-2.32%/yr vs -1.58%/yr, p=0.012). Baseline mean deviation (MD) and OCT parameters were associated with the rates of macular VD loss. Conclusions: OCTA measurements could detect vascular deterioration over time in POAG eyes at different stages. The rates of macular VD loss were significantly faster in more advanced POAG eyes.

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PurposeTo explore the association between constitution types as defined by traditional Chinese medicine (TCM) and risk for normal-tension glaucoma (NTG).DesignPopulation-based cohort study.MethodsPersons were identified in a population cohort aged ≥30 years with NTG, defined as having an untreated mean intraocular pressure measurement ≤21 mm Hg over six separate occasions, with no single reading >24 mm Hg (as in the Collaborative Normal Tension Glaucoma Study). The Body Constitution in Traditional Chinese Medicine Questionnaire was used to assess each participant’s TCM constitution types. The association between various constitutions and visual field progression according to Early Manifest Glaucoma Trial criteria was assessed using Cox regression HR models.ResultsAmong 142 participants (245 eyes), 23 persons (17.6%) and 25 eyes (10.2%) progressed, over a mean (SD) follow-up duration of 3.49 (0.99) years. Progression rates were highest in participants with Yang-deficient constitution (n=19, 13.4%), among whom 7 (36.8%) exhibited worsening fields. After adjusting for sex, age, central corneal thickness, retinal nerve fibre layer thickness and mean deviation on visual field testing, Yang-deficient constitution (HR 4.63, 95% CI 1.77 to 12.1, p=0.002) and higher mean intraocular pressure during follow-up (HR 1.25, 95% CI 1.01 to 1.56, p=0.044) were associated with field progression.ConclusionsYang-deficient constitution and higher intraocular pressure are risk factors for visual field progression in NTG patients. Yang deficiency is characterised by abnormal vasoregulation, and these results may be consistent with prior studies linking NTG progression to Raynaud’s phenomenon and migraine.