Risk factors for progression of normal‐tension glaucoma under β‐blocker monotherapy

Sung

Invest. Ophthalmol. Vis. Sci.

et al. 2015

PURPOSE.To evaluate the effect of optic disc tilt on the progression of glaucoma in myopic glaucomatous eyes.METHODS. The disc tilt ratio was estimated on disc photographs. Glaucomatous progression was determined either by stereoscopic optic disc/retinal nerve fiber layer photographs or serial visual field data. All participants were categorized into two groups according to tilt ratio (nontilted [<1.3] or tilted [ ‡1.3]). Kaplan-Meier life-table analysis was used to compare the survival experiences (time to confirmed glaucomatous progression) between groups. The hazard ratios (HRs) for the associations between potential risk factors and progression were determined by using Cox proportional hazards modeling. RESULTS.A total of 85 eyes in 85 myopic glaucoma patients (axial length > 24 mm; mean follow-up, 4.1 years) were included. Among them, 42 eyes (49.4%) demonstrated progression and 43 eyes (50.6%) were stable on follow-up. The mean disc tilt ratio was significantly smaller, and the prevalence of disc hemorrhage higher, in the progression than the stable group (P ¼ 0.032, P ¼ < 0.001, respectively). The cumulative probability of progression was 24.7% in the tilted group and 68.7% in the nontilted group (P ¼ 0.005). Disc hemorrhage (HR ¼ 3.317; P ¼ 0.001) and the tilt ratio (HR ¼ 0.110; P ¼ 0.046) were predictive of progression. CONCLUSIONS.Myopic eyes with tilted disc demonstrated a smaller probability of glaucomatous progression. Optic disc tilt may be protective against glaucoma progression, or tilted myopic glaucomatous eyes may have less progressive characteristic by nature.

mentioning

confidence: 99%

Implications of Optic Disc Tilt in the Progression of Primary Open-Angle Glaucoma

Sung

Invest. Ophthalmol. Vis. Sci.

et al. 2015

“…47,48 The mechanical theory for the pathogenesis of glaucoma hypothesises that the primary event is neurodegeneration of the optic nerve putting stress on blood vessels, eventually leading to bleeding. 49 Some individuals may be more prone to blood vessel breakage.…”

Section: Discussionmentioning

confidence: 99%

An examination of the hypothesis that intraocular pressure elevation episodes can have prognostic significance in glaucoma suspects

McMonnies

2015

Journal of Optometry

The efficacy of intraocular pressure reduction in retarding the progression of glaucoma has been demonstrated. This review examines the potential for prognostic advantage for glaucoma suspects in reducing their optic nerve head exposure to elevated intraocular pressure associated with activities which have been shown to elevate intraocular pressure. In this observational study, patients examined at the Centre for Eye Health (University of New South Wales) with a diagnosis of glaucoma suspect were surveyed to determine their histories for participation in activities which are known to elevate intraocular pressure. The evidence regarding the pathological significance of these sources of elevation in susceptible patients was examined. Apart from the universality of sleep-related intraocular pressure elevations, the histories from 183 confirmed glaucoma suspects indicate a wide range and variation in frequency of participation in other intraocular pressure elevating activities. A reduction in exposure to elevated intraocular pressure may improve the prognosis for glaucoma suspects. Additional patient specific assessment of the results of this screening could provide an indication of the degree (frequency, intensity level and duration) of exposure to elevated intraocular pressure. Such information may provide the basis for improving a patient's prognosis by helping them to identify opportunities to reduce such exposure to elevated intraocular pressure. Any benefit of reduction of such exposure appears likely to be greater if activities which elevate intraocular pressure are of long duration, occur frequently, occur over a long period of time, and/or involve high levels of intraocular pressure elevation.

Asia-Pacific Journal of Ophthalmology

“…[37][38][39][120][121][122] Despite lingering questions on whether disc hemorrhage is an indicator of progression or a risk factor for progression, there is no doubt that it has a significant impact on glaucoma progression.…”

Section: Monitoring Of Structural and Functional Progressionmentioning

confidence: 97%

Update on the Prevalence, Etiology, Diagnosis, and Monitoring of Normal-Tension Glaucoma

Kim

Park²

2016

Glaucoma is a leading cause of blindness worldwide. Normal-tension glaucoma (NTG) is a type of open-angle glaucoma with intraocular pressure measurements always 21 mm Hg or less. A controversy surrounding NTG is the question of whether it should be regarded as a disease within the spectrum of primary open-angle glaucoma or as a distinctive disease entity. Nonetheless, NTG does have distinctive features compared with primary open-angle glaucoma: intraocular pressure-independent risk factors for development of NTG, characteristic patterns of structural and functional damage, and a unique disease course. This review provides an overview and update on the current issues surrounding the prevalence, etiology, diagnosis, and monitoring of NTG.