Abstract
The purpose of this study was to identify risk factors associated with progressive retinal nerve fiber layer(RNFL) thinning of open-angle glaucoma(OAG) in patients whose intraocular pressure(IOP) was maintained low with medical treatment. Based on a retrospective review of medical records, OAG patients with ≥60 months of follow-up and mean IOP below 15 mmHg were recruited. All eyes underwent IOP measurement with Goldmann applanation tonometer(GAT), standard automated perimetry(SAP), and cirrus optical coherence tomography(cirrus OCT) at 6 month or 1 year intervals. RNFL thinning was assessed using the Guided Progression Analysis(GPA) software. Forty-one eyes of 41 patients (mean age 54.9 ± 13.5) were followed up for 77.8 ± 7.8 months. GPA detected 20 eyes (48.8%) with progressive RNFL thinning(−1.5 ± 0.5 um/year), who were subsequently classified as the ‘rapid progression group.’ Those whose rate of change in RNFL thickness was slower than −1.00 µm/year was classified as the ‘slow progression group’ (n = 21, −0.0 ± 0.4 um/year, P < 0.001). Mean IOP after initiating therapy was 13.2 ± 1.1 mmHg in the rapid progression group and 13.1 ± 1.3 mmHg in the slow progression group (P = 0.300; 14.8 ± 10.0% vs. 19.6 ± 12.4% reduction, P = 0.155). Disc hemorrhage was found to more frequently occur in the rapid progression group (P = 0.001). Multivariate logistic regression analysis showed that patients with disc hemorrhage were at a higher risk for progressive RNFL thinning in OAG (OR 37.529 95% CI 2.915–483.140) after adjusting for baseline co-variates (P = 0.005). In conclusion, disc hemorrhage is associated with progressive RNFL thinning in OAG with well-maintained IOP. Factors other than IOP appear to also play a role in OAG progression.
Highlights
The purpose of this study was to identify risk factors associated with progressive retinal nerve fiber layer(RNFL) thinning of open-angle glaucoma(OAG) in patients whose intraocular pressure(IOP) was maintained low with medical treatment
The rapid progression group consisted of 20 eyes with mean age of 56.4 ± 11.8 years at the time of diagnosis
The rapid progression and slow progression groups showed no statistically significant difference in mean deviation of the visual field test (−3.6 ± 3.3 dB for the rapid progression group vs. −4.7 ± 4.5 dB for the slow progression group; P = 0.406) and RNFL thickness (81.4 ± 7.7 μm for the rapid progression group vs. 76.7 ± 9.8 μm for the slow progression group; P = 0.095)
Summary
The purpose of this study was to identify risk factors associated with progressive retinal nerve fiber layer(RNFL) thinning of open-angle glaucoma(OAG) in patients whose intraocular pressure(IOP) was maintained low with medical treatment. GPA detected 20 eyes (48.8%) with progressive RNFL thinning(−1.5 ± 0.5 um/year), who were subsequently classified as the ‘rapid progression group.’. Disc hemorrhage is associated with progressive RNFL thinning in OAG with well-maintained IOP. Several studies to date have examined risk factors associated with progression of OAG. In light of the above, the purpose of the present study was to identify risk factors of progressive RNFL thinning in OAG patients whose IOP was adequately reduced and maintained below 15 mmHg with medical therapy
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