Comparison of Visual Field Progression Between Relatively Low and High Intraocular Pressure Groups in Normal Tension Glaucoma Patients

Lee, Jeongmin; Kong, Mingui; Kim, Jae Hui; Kee, Changwon

doi:10.1097/ijg.0b013e31829484c6

Cited by 40 publications

(26 citation statements)

References 55 publications

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“…In general, glaucoma progression was reported to accelerate in the middle stage and thereafter 16. In the present analysis using a Markov model, VFD aggravations in NTG were not conspicuous after the middle stage; instead, the progression seemed to be linear, as reported by Lee et al17 We conjectured that this observation may reflect an influence of medical therapy on the study subjects. We previously reported that the presence or absence of continuous aggravations of MD values was associated with long-term VFD during follow-up of NTG patients 18.…”

Section: Discussionsupporting

confidence: 72%

“…VFD progression in NTG was reported to involve not only IOP factors, but also local factors, such as severity of myopia,23 central corneal thickness,24 and disc hemorrhage 15,17,24. While, disc hemorrhage has been considered as a significant risk factor, it is not a highly specific prognostic factor because it is difficult to detect every occurrence of disc hemorrhage in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

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Effect of quantitative intraocular pressure reduction on visual field defect progression in normal tension glaucoma under medical therapy applying Markov model

Yoshikawa

Santo

Hizaki

et al. 2018

OPTH

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PurposeTo quantitatively evaluate the association of intraocular pressure (IOP) reduction with visual field defect (VFD) progression in normal tension glaucoma (NTG) under medical therapy.Patients and methodsClinical data for 622 eyes of 311 primary open-angle glaucoma and NTG patients were collected from April 2006 to March 2016. Of these patients, those with normal IOP, glaucomatous VFD by Anderson’s criteria, corrected visual acuity ≥0.7, >5 years of medical therapy, ≥5 visual field tests at least five times at 12-month intervals, visual field testing reliability coefficients of ≤33%, and mean deviation (MD) exceeding below −20 dB in the initial visual field test were included in this retrospective data analysis. MD and IOP data were collected at baseline and after 5 years. Following MD categorization into stages I to IV, stage transition matrices were generated using a Markov model to evaluate VFD changes. Eyes were divided based on IOP reduction (0%, 10%, 15%, 20%, 25%, 30%) from baseline. VFD aggravations were compared using the Markov model and MD slopes with IOP reduction rates as cutoff values.ResultsOverall, 132 eyes of 132 NTG patients fulfilled the eligibility criteria. MD decreased significantly (P<0.0001) at 5 years vs baseline. During follow-up, visual field stage using the Markov model was constant in ~60%, with transitions in ~40%. IOP decreased significantly (P>0.001) at 5 years vs baseline. Though MD slopes did not differ significantly between each of the groups that achieved the various IOP reduction cut-off values and the corresponding group that did not achieve the cut-off values, a significant difference (P=0.0432) in VFD was found between the group that achieved the 25% cut-off value and the group that did not when evaluated using the Markov model.ConclusionIn NTG patients, VFD aggravation was significantly suppressed in groups with IOP reductions of ≥25% from baseline.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Effect of quantitative intraocular pressure reduction on visual field defect progression in normal tension glaucoma under medical therapy applying Markov model

Yoshikawa

Santo

Hizaki

et al. 2018

OPTH

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“…Over four follow-up visits, each 6 months apart, the authors found no significant difference in either short-term or long-term IOP fluctuation between patients who progressed and those who remained stable. Lee et al 21 found comparable results in patients with NTG and at least 5 years of follow-up, reporting no significant association between SD in IOP and VF progression in univariate or multivariate analysis.…”

Section: Long-term Iop Fluctuationmentioning

confidence: 89%

Intraocular pressure fluctuation and glaucoma progression: what do we know?

et al. 2014

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While mean intraocular pressure (IOP) has long been known to correlate with glaucomatous damage, the role of IOP fluctuation is less clearly defined. There is extensive evidence in the literature for and against the value of short-term and long-term IOP fluctuation in the evaluation and prognosis of patients with glaucoma. We present here the arguments made by both sides, as well as a discussion of the pitfalls of prior research and potential directions for future studies. Until a reliable method is developed that allows for constant IOP monitoring, many variables will continue to hinder us from drawing adequate conclusions regarding the significance of IOP variation.

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“…In the group with pressure >15 mmHg, IOP was a risk factor for progression. However, in the group with lower pressures, the presence of optic disc hemorrhages was the only risk factor, demonstrating that progression mechanisms are not exclusively dependent on pressure values (84) . The risk factors for the progression of glaucomatous damage detected by the NTG Collaborative Study Group were female sex, mi graine, and occurrence of optic disc hemorrhage (85,86) .…”

Section: Visual Field Defects and Progressionmentioning

confidence: 99%

Normal-tension glaucoma: an update

Esporcatte¹,

Tavares²

2016

Arquivos Brasileiros De Oftalmologia

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However, several structural and functional differences support the fact that different mechanisms may have a stronger role in the pathogenesis of NTG versus high-pressure POAG. Also, a recent study reported genetic variants associated with different tendencies towards POAG with lower or higher IOP (6) . Furthermore, clinical impression and anecdotal evidence suggest that NTG with mean IOP in the high teens (>15 mmHg), in which circadian fluctuation and CCT could lead to a possible misdiagnosis of an IOP ≤21 mmHg, would differ from NTG with mean IOP in the low teens (≤15 mmHg), with different ABSTRACT Descritores: Glaucoma de ângulo aberto; Pressão in traocular; Doenças do nervo óptico; Anti-hipertensivos/uso terapêuticopathogenesis and progression patterns, harder to achieve target IOP, and higher incidence of disc hemorrhages. Nonetheless, a recent report does not support this assumption and underscores low-teens NTG as an important entity (7) . The proportion of NTG varies depending on different population studies. In Asian epidemiological protocols, NTG constituted the majority of open-angle glaucomas (52%-92%), depending on the country and study methodology (8) . Normal IOP was measured in 57.1% cases of POAG in a South African study (9) . In white populations, the proportion of NTG was lower than that observed in Asian and African populations. In studies conducted in the United States, Netherlands, and Italy, NTG presented proportions of 31. 7%, 38.9%, and 30%, respectively (10-12) . The etiology of NTG is most likely multifactorial and still not well defined. Moreover, several alternative treatments based on this different pathogenesis have been discussed. The objective of this study was to review the mechanisms involved in the onset and progression of NTG and the efficacy of established and alternative therapies for NTG treatment. PathogenesisThe pathogenesis of NTG is unclear, and perhaps the development of the disease is a consequence of a complex interaction of several systemic and ocular factors. Different studies have shown that the cardiovascular system and intracranial pressure may be involved in the main pathways of optic nerve damage. Nevertheless, the complex relationship between these mechanisms and glaucoma pro gression continues to be debated.

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Comparison of Visual Field Progression Between Relatively Low and High Intraocular Pressure Groups in Normal Tension Glaucoma Patients

Abstract: Although progression rate was similar, the risk factors for VF progression were different in the 2 groups. These findings may suggest that IOP-dependent and IOP-independent factors affect VF progression differently in the 2 groups.

Cited by 40 publications

References 55 publications

Effect of quantitative intraocular pressure reduction on visual field defect progression in normal tension glaucoma under medical therapy applying Markov model

Effect of quantitative intraocular pressure reduction on visual field defect progression in normal tension glaucoma under medical therapy applying Markov model

Intraocular pressure fluctuation and glaucoma progression: what do we know?

Normal-tension glaucoma: an update

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