Risk factors for disease progression in low-teens normal-tension glaucoma

Baek, Sung Uk; Ha, Ahnul; Kim, Dai Woo; Jeoung, Jin Wook; Park, Ki Ho; Kim, Young Kook

doi:10.1136/bjophthalmol-2018-313375

Cited by 23 publications

(36 citation statements)

References 26 publications

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“…Interestingly, DH was not involved with the factors contributing to faster VF progression rate in this study. The presence and/or number of DH have been reported to be related to the progression of glaucoma, especially NTG [28,34]. There could be several possible interpretations of this finding.…”

Section: Plos Onementioning

confidence: 87%

“…Few studies have assessed the risk factors for NTG progression in patients with well-controlled low-teen IOP. Recently, progression was reported in about 35% of the eyes of patients with low-teen NTG in more than 5 years [28]. Fluctuation of diastolic BP and diurnal IOP were suggested as systemic factors associated with progression risk in NTG patients with low-teen IOP [28].…”

Section: Plos Onementioning

confidence: 99%

“…Recently, progression was reported in about 35% of the eyes of patients with low-teen NTG in more than 5 years [28]. Fluctuation of diastolic BP and diurnal IOP were suggested as systemic factors associated with progression risk in NTG patients with low-teen IOP [28]. Since fluctuations in BP and IOP can periodically disturb and restore ocular perfusion, the mechanism of optic nerve damage may be similar to that caused by vasospasm.…”

Section: Plos Onementioning

confidence: 99%

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Relationship between peripheral vasospasm and visual field progression rates in patients with normal-tension glaucoma with low-teen intraocular pressure

et al. 2021

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Purpose To investigate the association between peripheral vasospasm and the visual field (VF) progression rate in patients with normal-tension glaucoma (NTG) with low-teen intraocular pressure (IOP). Methods The finger temperature of 113 NTG patients was measured before and after exposure to ice water using a Temperature gun (cold pressor test). These patients had confirmed VF progression, despite a low-teen IOP during a follow-up period of >5 years. VF progression rates were calculated as the slope of the visual field index (VFI) and mean deviation (MD) over time. Demographic, systemic, and ocular factors and VF progression rates were compared, based on the cold pressor test results. A regression analysis was used to investigate the factors affecting VF progression rates. Results Mean age, initial IOP, mean IOP during the follow-up period, and initial VF MD were 57.1 years, 15.8 mmHg, 12.0 mmHg, and -5.2 dB, respectively. When patients were divided into two groups (less vasospasm and more vasospasm) according to changes in temperature after exposure to ice water, the VF progression rate was significantly faster in the group with more vasospasm. In a multiple regression analysis, older age, worse initial VF MD, and greater decrease in finger temperature after ice water exposure were significantly associated with faster VF progression rates. Conclusion An excessive drop in finger temperature after exposure to ice water was significantly associated with faster VF progression in patients with low-teen NTG. This suggests that the blood flow in the optic nerve head may also be disturbed by peripheral vasospasm, accelerating glaucomatous damage regardless of IOP.

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Section: Plos Onementioning

confidence: 87%

Section: Plos Onementioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

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Relationship between peripheral vasospasm and visual field progression rates in patients with normal-tension glaucoma with low-teen intraocular pressure

et al. 2021

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“…For instance, the diurnal fluctuation in IOP may decrease from 8.6 to 4.9 mmHg, and this effect is more pronounced in phakic eyes [17]. This observation is particularly relevant to 'low-teens normal-tension' type of glaucoma, because a high degree of long-term diurnal IOP fluctuation is a significant risk factor in the progression of glaucoma [18]. In our case, IOP fluctuated by approximately 8 mmHg in the three years prior to TLE, which was reduced to approximately 2 mmHg after TLE.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Follow-Up After Successful Trabeculectomy: A Case Report of Reversal of Cupping and Recovery of Visual Field Progression

Nakakura

Asaoka²,

Kiuchi³

2021

Cureus

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Glaucoma is one of the leading causes of blindness worldwide, and reduction of intraocular pressure (IOP) is the only available evidence-based treatment that reduces visual field deterioration in glaucoma. We present a representative case of structural recovery and recovery of visual field progression after successful trabeculectomy (TLE) with long-term follow-up. A 35-year-old woman with glaucoma visited our hospital in 2008. The IOP in her right eye was 11 mmHg at the first visit, and subsequently increased to values in the high teens to 20 mmHg despite treatment with anti-glaucoma eye drops. During this period, the progression of this eye’s visual field deterioration was fast (mean deviation [MD] slope = −0.63 dB/year) and the optic disc cupping was advanced. In the seven-year period after successful TLE in 2014, the IOP declined to between 8 and 12 mmHg without any anti-glaucoma medication. During the first two years after TLE, the MD values were poorer than those before TLE. However, by 2020, MD values improved gradually to a state better than that before the surgery (MD slope during this period was +0.75 dB/year). The appearance of the optic disc was monitored using fundus photography, which showed optic disc morphological changes during topical glaucoma medication before and after TLE. In particular, a remarkable reversal of optic disc cupping enlargement started at two weeks after TLE, and the optic disc shape in 2021 was similar to that in 2008. Minimally invasive glaucoma surgeries are often preferred; however, our findings suggest that successful TLE followed by long-term rigorous IOP control can result in structural recoveries. Additionally, despite the deterioration in visual field in the early years after TLE, in the long term, it may settle down to the same level before the surgery with recovery of visual field progression, which may be a part of functional recovery.

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“…A Japanese study group recently reported that the probability of NTG patients progressing to unilateral blindness was 9.9% at 20 years [12], which suggests that the NTG prognosis would be more severe than expected from the CNTGS. Additionally, individual factors that increase the risk of progression in NTG patients, such as optic disc hemorrhage [4,13], migraine [4], female [4], or IOP fluctuation [14,15], can affect the decision of Korean glaucoma subspecialists on whether to start treatment in the real-world clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Normal-tension Glaucoma Management: A Survey of Glaucoma Sub-specialists in Korea

Han

Kim

et al. 2020

Korean J Ophthalmol

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Normal-tension glaucoma (NTG) is a form of primary open-angle glaucoma (POAG) that develops even within the normal range of intraocular pressure (IOP). It is characterized by glaucomatous optic neuropathy and the corresponding visual field defects. While NTG occurs in approximately 30% to 40% of patients with POAG in Western populations [1], it has been reported to be higher in East Asian populations. The Japanese Tajimi study [2] showed that NTG comprised 92% of POAG patients in its study population, and the Korean Namil study [3] reported a corresponding rate of 77%. Due to the high prevalence of NTG in East Asia, an effective acute management strategy is of utmost importance in this region. The Collaborative Normal-tension Glaucoma Study (CNTGS) [4] and the Low-pressure Glaucoma Treatment Study (LoGTS) [5,6] are two of the largest randomized dou-Purpose: To investigate the current management patterns of glaucoma subspecialists with regard to normal-tension glaucoma (NTG) in Korea and to determine the effect of the two largest NTG trials on their clinical practice. Methods: A questionnaire survey was sent to glaucoma subspecialist members of the Korean Glaucoma Society. The questionnaire concerned regular practice with respect to NTG and the extent to which it has been influenced by the Collaborative Normal-tension Glaucoma Study and the Low-pressure Glaucoma Treatment Study (LoGTS). Results: A total of 134 glaucoma subspecialists completed the survey, with a response rate of 56%. The survey reported that 88% and 78% of glaucoma subspecialists were familiar with the Collaborative Normal-tension Glaucoma Study and the LoGTS, respectively. With respect to mild or moderate NTG, most of the respondents (87%-91%) tended to treat their patients immediately without waiting for structural or functional progression. Among the respondents, 47 indicated that the LoGTS results-according to which, 20% of the respondents tended to use brimonidine more often-affected their management. The first-choice topical drugs for NTG were prostaglandin analogues (76%), brimonidine (9%), beta-blockers (8%), and topical carbonic anhydrase inhibitor (6%). Conclusions: Regarding mild-to-moderate NTG, Korean glaucoma subspecialists tended to initiate treatment without waiting for further progression. The impact of the LoGTS on NTG management was not dominant in clinical practice in Korea. Prostaglandin analogs are the most frequently selected first-choice drugs for the management of NTG in Korea.

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Risk factors for disease progression in low-teens normal-tension glaucoma

Cited by 23 publications

References 26 publications

Relationship between peripheral vasospasm and visual field progression rates in patients with normal-tension glaucoma with low-teen intraocular pressure

Relationship between peripheral vasospasm and visual field progression rates in patients with normal-tension glaucoma with low-teen intraocular pressure

Long-Term Follow-Up After Successful Trabeculectomy: A Case Report of Reversal of Cupping and Recovery of Visual Field Progression

Normal-tension Glaucoma Management: A Survey of Glaucoma Sub-specialists in Korea

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