The Relationship between Intraocular Pressure Reduction and Rates of Progressive Visual Field Loss in Eyes with Optic Disc Hemorrhage

Medeiros, Felipe A.; Alencar, Luciana M.; Sample, Pamela A.; Zangwill, Linda M.; Susanna, Remo; Weinreb, Robert N.

doi:10.1016/j.ophtha.2010.02.015

Cited by 80 publications

(67 citation statements)

References 22 publications

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“…-1.1 dB/year) when compared with commonly reported rates of progression in treated patients. In fact, rates of progression usually range between 0.3 and 0.6 dB/year as reported in the published literature [6,7,9,33]. All of these patients had POAG, and other ‘more aggressive' forms (e.g.…”

Section: Discussionmentioning

confidence: 87%

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Citicoline Oral Solution in Glaucoma: Is There a Role in Slowing Disease Progression?

et al. 2013

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Purpose: To assess the effect of citicoline on visual field rates of progression in patients with progressing glaucoma. Patients and Methods: Forty-one patients with a diagnosis of progressing glaucoma received citicoline in oral solution for 2 years. Included were patients with a disease progression of at least -1 dB/year (at MD, mean deviation) for at least 3 years before entering the study despite controlled intraocular pressure (IOP). Patients were followed with 4 visual field examinations per year for 2 years. Results: At baseline, the mean rate of progression was -1.1 (±0.7) dB/year despite the fact that the IOP had been below 18 mm Hg for at least 3 years. At study inclusion, the mean IOP was 15.5 (±2.6) mm Hg and the mean MD was -9.2 (±6.7) dB in the worst eye. Starting from the first cycle of treatment with citicoline, the mean rate of progression significantly changed to -0.15 (±0.3) dB/year at the end of the study (p = 0.01). Conclusions: This study seems to indicate that supplementation with citicoline might significantly slow down glaucomatous rates of progression.

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Section: Discussionmentioning

confidence: 87%

“…Despite the relationship between lower IOP and reduced glaucoma progression [6,7,8,9], there are patients showing significant field deterioration with so-called ‘well-controlled' IOP levels [10]. For these cases alternative treatments are considered including neuroprotection [11,12].…”

Section: Introductionmentioning

confidence: 99%

Citicoline Oral Solution in Glaucoma: Is There a Role in Slowing Disease Progression?

et al. 2013

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“…There is a report showing that rate of VF progression was different before and after DH, and this was related to the reduction of IOP in the posthemorrhage period due to enhanced treatment. 29 This may in part explain why the global rates of VF progression were not significantly different between eyes with nonrecurrent and recurrent DH. The number of glaucoma medications at the last follow-up visit was not different between nonrecurrent and recurrent DH groups in our study; however, this issue may have affected the results of this study.…”

Section: Figurementioning

confidence: 99%

Clinical Significance of the Location of Recurrent Optic Disc Hemorrhage in Glaucoma

Kim

2015

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To compare clinical characteristics and visual field (VF) progression between glaucomatous eyes with disc hemorrhage (DH) recurring at the same or different locations in relation to the initial DH location. METHODS.One hundred forty-seven open-angle glaucoma patients with DH who were observed for more than 4 years and had more than six VF tests were included. Disc hemorrhage that recurred at the same location as the initial DH was defined as a DH at the same location, and DH that recurred at a different location was defined as a DH at a different location. Overall rate of VF change using the mean deviation (MD) was compared between groups using a linear mixed model, and Kaplan-Meier survival analysis was performed.RESULTS. Seventy-seven (52.4%) eyes had nonrecurrent DH, and 70 (47.6%) eyes had recurrent DH detected during the follow-up period. Recurrent DH at the same location (À0.32 dB/y) was not significantly different from the nonrecurrent DH group in terms of the rate of VF change (P ¼ 0.116). However, the recurrent DH group at different locations (À1.07 dB/y) had a significantly different rate of VF change compared to the recurrent DH group at the same location (P ¼ 0.014). By Kaplan-Meier analysis, eyes with recurrent DH at different locations showed the fastest time to VF progression compared to other groups (log rank test, P < 0.001).CONCLUSIONS. Eyes with recurrent DH recurring at different locations from initial DH sites had more pronounced VF progression.

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“…The outcomes of such studies can be generalised only to similar patients and there is a risk that a treatment effect may be incorrectly estimated if the treatment is more, or less, effective in the trial cohort than in the target clinic population. Disc haemorrhages, for example, are well known to be a risk factor for glaucoma deterioration 99,120 and, although IOP lowering may be beneficial in these eyes, 121 the incidence of disc haemorrhages does not seem to be affected by IOP-lowering treatment. 122 If disc haemorrhages represent, at least in part, a non-IOP-related risk, then enriching a population with patients with a history of disc haemorrhages in a study assessing the effect of IOP lowering may not increase study power and may, in fact, have the opposite effect.…”

Section: Quigleymentioning

confidence: 99%

Combining optical coherence tomography with visual field data to rapidly detect disease progression in glaucoma: a diagnostic accuracy study

Garway-Heath

Zhu

Qian

et al. 2018

Health Technol Assess

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Background Progressive optic nerve damage in glaucoma results in vision loss, quantifiable with visual field (VF) testing. VF measurements are, however, highly variable, making identification of worsening vision (‘progression’) challenging. Glaucomatous optic nerve damage can also be measured with imaging techniques such as optical coherence tomography (OCT). Objective To compare statistical methods that combine VF and OCT data with VF-only methods to establish whether or not these allow (1) more rapid identification of glaucoma progression and (2) shorter or smaller clinical trials. Design Method ‘hit rate’ (related to sensitivity) was evaluated in subsets of the United Kingdom Glaucoma Treatment Study (UKGTS) and specificity was evaluated in 72 stable glaucoma patients who had 11 VF and OCT tests within 3 months (the RAPID data set). The reference progression detection method was based on Guided Progression Analysis™ (GPA) Software (Carl Zeiss Meditec Inc., Dublin, CA, USA). Index methods were based on previously described approaches [Analysis with Non-Stationary Weibull Error Regression and Spatial enhancement (ANSWERS), Permutation analyses Of Pointwise Linear Regression (PoPLR) and structure-guided ANSWERS (sANSWERS)] or newly developed methods based on Permutation Test (PERM), multivariate hierarchical models with multiple imputation for censored values (MaHMIC) and multivariate generalised estimating equations with multiple imputation for censored values (MaGIC). Setting Ten university and general ophthalmology units (UKGTS) and a single university ophthalmology unit (RAPID). Participants UKGTS participants were newly diagnosed glaucoma patients randomised to intraocular pressure-lowering drops or placebo. RAPID participants had glaucomatous VF loss, were on treatment and were clinically stable. Interventions 24-2 VF tests with the Humphrey Field Analyzer and optic nerve imaging with time-domain (TD) Stratus OCT™ (Carl Zeiss Meditec Inc., Dublin, CA, USA). Main outcome measures Criterion hit rate and specificity, time to progression, future VF prediction error, proportion progressing in UKGTS treatment groups, hazard ratios (HRs) and study sample size. Results Criterion specificity was 95% for all tests; the hit rate was 22.2% for GPA, 41.6% for PoPLR, 53.8% for ANSWERS and 61.3% for sANSWERS (all comparisons p ≤ 0.042). Mean survival time (weeks) was 93.6 for GPA, 82.5 for PoPLR, 72.0 for ANSWERS and 69.1 for sANSWERS. The median prediction errors (decibels) when the initial trend was used to predict the final VF were 3.8 (5th to 95th percentile 1.7 to 7.6) for PoPLR, 3.0 (5th to 95th percentile 1.5 to 5.7) for ANSWERS and 2.3 (5th to 95th percentile 1.3 to 4.5) for sANSWERS. HRs were 0.57 [95% confidence interval (CI) 0.34 to 0.90; p = 0.016] for GPA, 0.59 (95% CI 0.42 to 0.83; p = 0.002) for PoPLR, 0.76 (95% CI 0.56 to 1.02; p = 0.065) for ANSWERS and 0.70 (95% CI 0.53 to 0.93; p = 0.012) for sANSWERS. Sample size estimates were not reduced using methods including OCT data. PERM hit rates were between 8.3% and 17.4%. Treatment effects were non-significant in MaHMIC and MaGIC analyses; statistical significance was altered little by incorporating imaging. Limitations TD OCT is less precise than current imaging technology; current OCT technology would likely perform better. The size of the RAPID data set limited the precision of criterion specificity estimates. Conclusions The sANSWERS method combining VF and OCT data had a higher hit rate and identified progression more quickly than the reference and other VF-only methods, and produced more accurate estimates of the progression rate, but did not increase treatment effect statistical significance. Similar studies with current OCT technology need to be undertaken and the statistical methods need refinement. Trial registration Current Controlled Trials ISRCTN96423140. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 4. See the NIHR Journals Library website for further project information. Data analysed in the study were from the UKGTS. Funding for the UKGTS was provided through an unrestricted investigator-initiated research grant from Pfizer Inc. (New York, NY, USA), with supplementary funding from the NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK. Imaging equipment loans were made by Heidelberg Engineering, Carl Zeiss Meditec and Optovue (Fremont, CA, USA). Pfizer, Heidelberg Engineering, Carl Zeiss Meditec and Optovue had no input into the design, conduct, analysis or reporting of any of the UKGTS findings or this work. The sponsor for both the UKGTS and RAPID data collection was Moorfields Eye Hospital NHS Foundation Trust. David F Garway-Heath, Tuan-Anh Ho and Haogang Zhu are partly funded by the NIHR Biomedical Research Centre based at Moorfields Eye Hospital and UCL Institute of Ophthalmology. David F Garway-Heath’s chair at University College London (UCL) is supported by funding from the International Glaucoma Association.

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The Relationship between Intraocular Pressure Reduction and Rates of Progressive Visual Field Loss in Eyes with Optic Disc Hemorrhage

Cited by 80 publications

References 22 publications

Citicoline Oral Solution in Glaucoma: Is There a Role in Slowing Disease Progression?

Citicoline Oral Solution in Glaucoma: Is There a Role in Slowing Disease Progression?

Clinical Significance of the Location of Recurrent Optic Disc Hemorrhage in Glaucoma

Combining optical coherence tomography with visual field data to rapidly detect disease progression in glaucoma: a diagnostic accuracy study

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