Risk factors for visual field damage progression in normal-tension glaucoma eyes

Daugeliene, Lina; Yamamoto, Tetsuya; Kitazawa, Yoshiaki

doi:10.1007/s004170050203

Cited by 87 publications

(41 citation statements)

References 15 publications

(19 reference statements)

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“…There is also sufficient evidence that optic disc hemorrhage is an important risk factor for glaucoma progression (Daugeliene et al, 1999;Leske et al, 2003;Bengtsson et al, 2008;Prata et al, 2010). Additionally, increasing peripapillary atrophy, which might be related with hypoperfusion to the ONH, was reportedly associated with progressive glaucoma (Araie et al, 1994;Uchida et al, 1998;Daugeliene et al, 1999), and it has been reported that non-use of calcium channel blockers was significantly associated with the progression of visual field loss in NTG (Daugeliene et al, 1999). Clinically usable methods for the measurement of ONH blood flow include fluorescein fundus angiography, scanning laser Doppler flowmetry, and laser speckle flowgraphy.…”

Section: Introductionmentioning

confidence: 99%

Optic Nerve Head Blood Flow in Glaucoma

Sugiyama¹,

Shibata²,

Kojima³

et al. 2011

The Mystery of Glaucoma

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Section: Introductionmentioning

confidence: 99%

Optic Nerve Head Blood Flow in Glaucoma

Sugiyama¹,

Shibata²,

Kojima³

et al. 2011

The Mystery of Glaucoma

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“…Other reports studying various IOP parameters, measured during the same period and the same conditions, have been unable to show that large IOP fluctuation is an independent risk for glaucoma, 10 or glaucoma progression. 11 On the other hand, results from the Advanced Glaucoma Intervention Study (AGIS) 12 indicated that a larger long-term IOP fluctuation at follow-up, 13 defined as inter-visit fluctuations of IOP, was associated with visual field progression. Mean follow-up IOP was not a significant risk factor when included in the same multivariate analysis.…”

mentioning

confidence: 99%

Fluctuation of Intraocular Pressure and Glaucoma Progression in the Early Manifest Glaucoma Trial

et al. 2007

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Purpose: To investigate whether increased fluctuation of intraocular pressure (IOP) is an independent factor for glaucoma progression.Design: Cohort of patients followed in a randomized clinical trial.Participants: Two hundred and fifty-five glaucoma participants of the Early Manifest Glaucoma Trial (EMGT; 129 treated and 126 control patients.)Methods: Study visits, conducted every three months, included ophthalmologic examinations, IOP measurements and standard automated perimetry, with fundus photography every six months. IOP values were included only until the time of progression, in those eyes that showed such progression. Individual mean follow-up IOP and IOP fluctuation, calculated as the standard deviation of IOP at applicable visits, were the variables of main interest. Cox regression with time-dependent variables was used to evaluate the association between IOP fluctuation and time to progression, both with and without IOP mean in the models. These analyses also controlled for other significant variables.Main Outcome Measures: Glaucoma progression, as defined by a predetermined visual field criterion, and/or worsening of the disk, assessed by an independent disk reading center.Results: Median follow-up time was 8 years (ranging from 0.1 to 11.1 years). Sixty-eight percent of the patients progressed. When considering mean follow-up IOP and IOP fluctuation in the same time-dependent model, mean IOP was a significant risk factor for progression. The hazard ratio (HR) was 1.11 (95% confidence interval: 1.06, 1.17; p<0.0001). IOP fluctuation was not related to progression, with a HR=1.00 (0.81, 1.24; p=0.999).Conclusion: These results confirm our earlier finding that elevated IOP is a strong factor for glaucoma progression, with the HR increasing by 11% for every mmHg of higher IOP. IOP fluctuation was not an independent factor in our analyses, a finding that conflicts with some earlier reports. One explanation for the discrepancy is that our analyses did not include postprogression IOP values, which would be biased towards larger fluctuations because of more intensive treatment. In contrast, in this EMGT report, no changes in patient management occurred during the period analyzed.

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“…Although data are now available that strongly support the role of IOP control in reducing the rate of progressive loss of visual field in POAG, 44,45 the existence of additional risk factors for progression in POAG from routine clinical data does not appear to have been fully explored, although a number of reports are available for normal tension glaucoma. [18][19][20][21] In the recent past, prospective data have become available from the Early Manifest Glaucoma Trial (EMGT) on risk factors for progression of open-angle glaucoma (both normal tension of glaucoma (NTG) and POAG). 24 However, because of limited evidence it remains uncertain as to whether differences exist between risk factors for initial development of POAG and for progression of glaucomatous damage.…”

Section: Discussionmentioning

confidence: 99%

“…17 In clinical situations, the ability to identify individuals who have a higher likelihood of progressive glaucomatous damage is desirable to identify those patients who may require further treatment intervention. To date, a number of investigators have studied prognostic factors associated with progressive normal-tension glaucoma, 14,[18][19][20][21] but limited attempts have been made to identify risk factors for progressive POAG in treated patients. [22][23][24] The aim of this study was to evaluate routine ophthalmic data to identify clinically useful risk factors for progressive visual field loss in patients with POAG already receiving intraocular pressure-lowering treatments.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for progressive visual field loss in primary open angle glaucoma

Spry

Sparrow

Diamond

et al. 2004

Eye

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Purpose The aim of this study was to evaluate routine ophthalmic data to identify clinically useful risk factors for progressive visual field loss in patients with primary openangle glaucoma (POAG) already receiving intraocular pressure-lowering treatments. Methods A retrospective cohort study design was used. Routine ophthalmic data for all subjects were obtained from case records with the knowledge that baseline clinical data had been collected in a standardised manner. Progression was defined according to the AGIS visual field defect scoring system. Variables evaluated as candidate risk factors for progression were assessed by survival analysis. Factors exerting a significant effect on survival were subsequently tested in a Cox proportional hazards model. Results A cohort of 108 eligible POAG patients was followed over an average of 3.6 years, with an average visual field intertest interval of 8 months. The incidence rate of progressive loss among the cohort was 5.4 cases per 100 person years. Increasing age was found to be independently associated with a small but significantly increased risk of glaucomatous visual field defect progression (hazard ratio 1.07, P ¼ 0.022), and a borderline association was also demonstrated with being male (hazard ratio 2.76, P ¼ 0.057). Conclusions This retrospective investigation has provided preliminary information on factors associated with increased risk of progressive glaucomatous visual field loss that may inform clinical care strategies. Lack of concordance with other studies suggests that further prospective investigations are needed if risk stratification strategies are to be employed in caring for patients with chronic open-angle glaucoma.

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Risk factors for visual field damage progression in normal-tension glaucoma eyes

Abstract: Risk factors unrelated to IOP were suggested to be associated with progression of visual field loss. Systemic use of Ca(2+)-channel blockers has a favorable effect on visual field prognosis in NTG eyes.

Cited by 87 publications

References 15 publications

Optic Nerve Head Blood Flow in Glaucoma

Optic Nerve Head Blood Flow in Glaucoma

Fluctuation of Intraocular Pressure and Glaucoma Progression in the Early Manifest Glaucoma Trial

Risk factors for progressive visual field loss in primary open angle glaucoma

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