Correlation between intraocular pressure level and optic disc changes in high-tension glaucoma suspects

Abstract

Purpose To assess the correlation between intraocular pressure (IOP) and future optic disc changes in eyes of patients suspected of having high-tension glaucoma and to determine the target pressure in eyes of patients suspected of having high-tension glaucoma. Design Prospective, comparative, observational case series. Participants Fifty-seven eyes of 57 patients suspected of having high-tension glaucoma selected from 226 consecutive patients with glaucoma or suspected glaucoma. Intervention The status of the optic disc and visual fields was evaluated during an initial examination by confocal laser ophthalmoscopy and automatic perimetry, respectively. Fifty-seven eyes were followed up for at least 2.5 years and then underwent a final examination. IOP was measured every 3 months. Main outcome measures The correlation between changes in optic disc status and IOP control during follow-up was determined. Changes in the optic disc were evaluated by using the percentage change in total contour area, neuroretinal rim area, and cup-to-disc ratio. The control IOPs were evaluated on the basis of the percentage of time during which IOP was <18 mmHg (%<18 mmHg control) and <21 mmHg (%<21 mmHg control) during follow-up in each eye. The correlation between visual field changes and IOP control was also analyzed. Results Results from 48 (84.2%) of 57 participants were included. Patients were followed up for a mean 4.4 years. The %<21 mmHg control was significantly correlated with changes in neuroretinal rim area ( r = 0.40; P = 0.0055) and in cup-to-disc ratio ( r = −0.40; P = 0.0051) by linear regression analysis. The correlations were also significant if the difference in the length of follow-up was adjusted by multivariate regression analysis. There was no significant correlation between %<18 mmHg control and changes in disc parameters. Seven (14.6%) of 48 eyes had glaucomatous visual field defects at the final examination. The %<21 mmHg control was significantly lower in eyes with visual field changes compared with eyes with no changes ( P = 0.0153; unpaired t test). In contrast, %<18 mmHg control was not significantly different between eyes with and without visual field changes ( P = 0.3886). Conclusions The IOP level correlates with topographic changes in the optic disc in eyes of patients suspected of having high-tension glaucoma. The target pressure for such eyes may need to be between 18 and 21 mmHg, and <18 mmHg is a safe target level in the treatment of patients suspected of having high-tension glaucoma to delay topographic optic disc changes.