Relationship between peripheral vasospasm and visual field progression rates in patients with normal-tension glaucoma with low-teen intraocular pressure.

James Fielding Hejtmancik,Do Young Park,Eun Jung Lee,Jong Chul Han,Changwon Kee

doi:10.1371/journal.pone.0250085

James Fielding Hejtmancik, Do Young Park + Show 3 more

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https://doi.org/10.1371/journal.pone.0250085

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Abstract

PurposeTo investigate the association between peripheral vasospasm and the visual field (VF) progression rate in patients with normal-tension glaucoma (NTG) with low-teen intraocular pressure (IOP).MethodsThe finger temperature of 113 NTG patients was measured before and after exposure to ice water using a Temperature gun (cold pressor test). These patients had confirmed VF progression, despite a low-teen IOP during a follow-up period of >5 years. VF progression rates were calculated as the slope of the visual field index (VFI) and mean deviation (MD) over time. Demographic, systemic, and ocular factors and VF progression rates were compared, based on the cold pressor test results. A regression analysis was used to investigate the factors affecting VF progression rates.ResultsMean age, initial IOP, mean IOP during the follow-up period, and initial VF MD were 57.1 years, 15.8 mmHg, 12.0 mmHg, and -5.2 dB, respectively. When patients were divided into two groups (less vasospasm and more vasospasm) according to changes in temperature after exposure to ice water, the VF progression rate was significantly faster in the group with more vasospasm. In a multiple regression analysis, older age, worse initial VF MD, and greater decrease in finger temperature after ice water exposure were significantly associated with faster VF progression rates.ConclusionAn excessive drop in finger temperature after exposure to ice water was significantly associated with faster VF progression in patients with low-teen NTG. This suggests that the blood flow in the optic nerve head may also be disturbed by peripheral vasospasm, accelerating glaucomatous damage regardless of IOP.

Highlights

It is well known that several vascular factors besides intraocular pressure (IOP) are associated with the development and progression of glaucoma, especially in those with normal-tension glaucoma (NTG) [1,2,3]
When patients were divided into two groups according to changes in temperature after exposure to ice water, the visual field (VF) progression rate was significantly faster in the group with more vasospasm
In a multiple regression analysis, older age, worse initial VF mean deviation (MD), and greater decrease in finger temperature after ice water exposure were significantly associated with faster VF progression rates

Summary

Introduction

It is well known that several vascular factors besides intraocular pressure (IOP) are associated with the development and progression of glaucoma, especially in those with normal-tension glaucoma (NTG) [1,2,3]. Ischemic damage from the low ocular perfusion pressure and ischemic reperfusion have been suggested to induce axonal damage through reactive oxygen species [2, 7, 8]. Repetitive tissue damage from ischemic reperfusion injuries are observed in various vasospastic disorders, including Raynaud disease, migraine, and variant angina, which show over-reactivity to common stimuli, such as cold, stress, or hypoxia [9]. Vasospasm has long been an issue for its role in the pathogenesis of glaucoma, especially NTG, in terms of development and progression [10, 11]. We hypothesized that vasospasm, which could interfere with ocular perfusion and cause ischemic reperfusion injury, could cause an additional harmful effect on the optic nerve head (ONH) where glaucomatous damage has already occurred

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