Abstract
PurposeTo investigate the site specificity of visual field changes in eyes with normotensive preperimetric glaucoma (PPG), and to determine factors influencing visual field progression.MethodsThis prospective study comprised 84 eyes of 84 normotensive PPG patients followed for at least 16 months. Optic nerve head (ONH) blood flow was assessed with tissue-area mean blur rate (MBRT), derived from laser speckle flowgraphy. Total deviation (TD) was measured in each sector of the Garway-Heath map to evaluate the site specificity of visual field loss. Subjects with a TD slope in the first quartile were classified as progressive, and other subjects as nonprogressive. Linear and multiple regression analyses were performed to determine factors affecting visual field progression.ResultsTD in the superior sector significantly decreased in the subjects overall during the follow-up periods (−0.48 ± 1.92 dB/y, P = 0.025). Linear regression analysis showed that basal MBRT-inferior was correlated significantly with TD-superior slope (r = 0.332, P = 0.002). Furthermore, basal MBRT was significantly lower in this sector in the progressive than the nonprogressive group (P = 0.010). Multiple linear regression analysis revealed that basal MBRT-inferior was the only predictive factor for TD-superior slope (β = 0.329, P = 0.005).ConclusionsThese findings suggest that superior-sector visual field progression is most common in normotensive PPG eyes, and that reduced basal ONH blood flow is associated with visual field progression.Translational RelevanceThese findings provide new insight into the involvement of ONH blood flow impairment in glaucoma pathogenesis, and demonstrate the importance of assessing ONH blood flow to determine visual field progression in normotensive PPG.
Highlights
Translational Relevance: These findings provide new insight into the involvement of optic nerve head (ONH) blood flow impairment in glaucoma pathogenesis, and demonstrate the importance of assessing ONH blood flow to determine visual field progression in normotensive PPG
The present study focused on the superior visual field, because statistically significant visual field progression was observed in this region (Table 2), and there was a significant relationship between TD slope and basal ONH blood flow in the inferior region in the site-specific visual field evaluation (Fig. 2)
Previous retrospective studies have reported that the average mean deviation (MD) slope in PPG eyes ranged from À0.09 to À0.39 dB/y, that more than 50% of eyes developed glaucomatous visual field loss within a 5-year follow-up period,[14,15] and that intraocular pressure (IOP)-lowering therapy was effective for controlling visual field progression in PPG eyes.[10]
Summary
Glaucomatous morphologic changes and visual field impairment, even during PPG. Glaucoma diagnosis is based on glaucomatous morphologic changes (detected with funduscopy) or visual field impairment (measured with automated static perimetry). These methods can be difficult or misleading to correctly diagnose to PPG. New technologies, such as optical coherence tomography (OCT)-based fundus imaging and new perimetric techniques, have become available for clinical use, thereby improving the assessment of PPG progression.[3,4,5] risk factors for PPG pathogenesis still remained poorly understood
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