Visual Field Progression In Patients Research Articles

The Effect of Exercise on Intraocular Pressure and Glaucoma.

A review of the literature found that certain types of exercise and physical activity result in transient reductions in intraocular pressure and may have a beneficial effect on glaucoma severity and progression. Glaucoma is the most common cause of irreversible vision loss worldwide. Raised intraocular pressure (IOP) is the most important risk factor for the disease. Exercise is known to result in changes in IOP. The purpose of this review was to investigate the effect of exercise on IOP and glaucoma. A comprehensive search of multiple literature databases was performed. Medline, EMBASE, and Cochrane libraries were used to search for the relevant terms. 16 original studies were selected for the review. Exercise of varying intensity and type has differing effects on IOP. Moderate-intensity aerobic exercise results in transient reductions in IOP, while high-intensity resistance exercise and weight-lifting lead to transient elevations in IOP. There is evidence to suggest that exercise and higher levels of fitness may be protective against the development of glaucoma. In addition, increased daily physical activity may be associated with less visual field progression in patients with glaucoma. While secondary causes of glaucoma are included in some of the studies discussed in this review, the findings are largely applicable to primary open angle glaucoma. Exercise may be a beneficial lifestyle modification in the management of glaucoma; however, further longitudinal studies are required to validate this.

Associations of long-term fluctuation in blood pressure and ocular perfusion pressure with visual field progression in normal-tension glaucoma

BackgroudThe aim of this study was to investigate the associations between fluctuation in blood pressure (BP), ocular perfusion pressure (OPP) and visual field (VF) progression in normal-tension glaucoma (NTG).MethodsThis prospective, longitudinal study included 44 patients with NTG. Only newly diagnosed NTG patients who had not been treated with a glaucoma medication were included. Patients were examined every year for 7 years. Intraocular pressure (IOP), heart rate (HR), systolic BP (SBP), diastolic BP (DBP), ocular perfusion pressure (OPP), and diastolic ocular perfusion pressure (DOPP) were measured at the same time. Ophthalmic examinations, including perimetry, were performed also. Initial VF were compared with follow-up data after 7 years.ResultsAfter 7 years of follow-up, 9 of the 44 patients showed VF progression. The standard deviation (SD) of SBP and OPP were significantly associated with VF progression (P = 0.007, < 0.001, respectively). Multiple regression analysis showed that VF progression was significantly associated with SD of OPP (odds ratio, OR = 2.012, 95% CI = 1.016–3.985; P = 0.045).ConclusionsFluctuation in OPP was associated with VF progression in patients with NTG.

Association between Serum Potassium with Risk of Onset and Visual Field Progression in Patients with Primary Angle Close Glaucoma: A Cross-Sectional and Prospective Cohort Study

Evidence suggests that ion metabolism may be associated with oxidative stress in the ocular tissue in glaucoma patients. This study is aimed at determining whether serum ion levels are associated with the onset and/or visual field (VF) progression of PACG. A total of 265 PACG and 166 healthy subjects were included in the cross-sectional study. Meanwhile, 265 subjects with PACG were followed up every six months for at least two years in the cohort study. All subjects were evaluated for serum concentrations of ions (calcium, phosphorus, potassium (K+), sodium, and chlorine) and underwent VF examination. Logistic regression analysis was performed to assess the risk factors for PACG. Cox regression analyses and Kaplan-Meier survival analyses were performed to identify factors associated with VF progression in PACG subjects. In the cross-sectional study, the K+ level (4.31 ± 0.39 mmol/L) was significantly higher in the PACG group than in the normal group (4.16 ± 0.35 mmol/L, P < 0.001). Multiple logistic regression showed that the increased K+ level was a risk factor of PACG (OR = 2.94, 95%CI = 1.63–5.32, P < 0.001). In the cohort study, there were 105 PACG subjects with progression and 160 PACG subjects without progression. The progression group had significantly higher baseline serum K+ levels (4.41 ± 0.37 mmol/L) than the no progression group (4.25 ± 0.39 mmol/L) (P = 0.002). The increased level of K+ at baseline was associated with faster VF progression (HR = 2.07, 95%CI = 1.23–3.46, P = 0.006). PACG subjects with higher baseline K+ levels had significantly lower VF nonprogression rates (51.94%) than subjects with lower K+ levels (68.38%, log-rank test P = 0.01). This study found that increased serum K+ level is a risk factor of PACG and is associated with faster VF progression in PACG, which might result from its influence on the oxidative stress process.

Visual Field Progression in Patients with Primary Open Angle Glaucoma, Normal Tension Glaucoma, and Primary Angle Closure Glaucoma

Purpose: We compared visual field progression among patients with primary open-angle glaucoma (POAG), normal tension glaucoma (NTG), and primary angle-closure glaucoma (PACG).Methods: A total of 115 POAG, 123 NTG, and 92 PACG eyes were retrospectively analyzed. Global VF progression was evaluated by calculating the changes of mean deviations. To examine local VF deterioration, scotoma enlargement and deepening were analyzed in the superior, and inferior arcuate, and the central, zones.Results: The mean global rate of change in POAG eyes was -0.52 ± 0.74 dB/year, and -0.35 ± 0.41, and -0.38 ± 0.45 dB/year in NTG and PACG eyes; POAG eyes showed significantly more rapid progression than NTG and PACG eyes (p &lt; 0.01). The superior arcuate zone of POAG eyes, the central zone of NTG eyes, and the inferior arcuate zone of PACG eyes exhibited more scotoma enlargement and scotoma deepening than did other zones.Conclusions: The superior arcuate zone of POAG eyes, the central zone of NTG eyes, and the inferior arcuate zone of PACG eyes showed greater VF progression.

Multilayer Macula Vessel Density and Visual Field Progression in Glaucoma

To evaluate the association of macular superficial vessel density (SVD) and projection-resolved deep vessel density (DVD) with past visual field (VF) progression in patients with primary open-angle glaucoma. Retrospective cohort. In this longitudinal study, 208 eyes of 147 patients with glaucoma from the Diagnostics Innovations in Glaucoma Study were included. Eligible participants were required to have at least five 24-2 VF tests over a minimum follow-up period of 3 years before macular optical coherence tomography angiography imaging. VF progression was defined based on both event-based pointwise linear regression and trend-based methods. The association of macular SVD and DVD with the probability and rate of past VF progression was evaluated using a linear mixed effects model. Fifty-two (25%) eyes had VF progression based on the pointwise linear regression based criterion at the end of a mean ± standard deviation follow-up duration of 6.9 ± 1.2 years. In the event-based multivariable analysis, a lower baseline SVD was associated with a higher likelihood of past VF progression (odds ratio per 1% lower. 1.28; 95% confidence interval, 1.02-1.59). Similarly, in the trend-based multivariable analysis, lower macular SVD was associated with a faster past rate of mean deviation decline (coefficient=-0.03 dB/year; 95% confidence interval, -0.04 to -0.01). Event-based and trend-based analyses found no significant associations for macular DVD with the likelihood/rate of past VF progression (P > .05). Lower macular SVD, and not DVD, was associated with a higher probability of past VF progression. Macular optical coherence tomography angiography imaging shows promise for identifying eyes at risk of VF progression in patients with glaucoma.

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

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.

Visual field progression in patients with severe glaucoma.

To assess the cumulative risk of progression in glaucomatous eyes in the severe stage of disease. This was a retrospective observational study. Patients that had severe damage in at least one eye, as defined by three criteria including a mean deviation of ≤ - 20dB, were included. Glaucoma progression was defined as a loss of ≥ 2dB in mean deviation confirmed in three consecutive visual field tests, or a persistent loss of two or more lines of vision-not attributable to non-glaucomatous causes-in three consecutive follow-up examinations. Kaplan-Meier survival analysis was used to assess the cumulative incidence of progression of the first eye to reach endpoint in cases where both eyes were eligible. A total of 143 eyes from 119 patients, were studied over a mean period of 4.9 ± 2.9years. Baseline mean deviation was - 25.3 ± 3.6dB. Twenty-three eyes of 22 patients reached the progression endpoint: 14 eyes by visual field criteria and 9 by visual acuity criteria. The cumulative 5-year risk of progression estimated by Kaplan-Meier analysis was 14.6% (95% confidence interval: 6.1-22.2%). In severe glaucoma patients, we found a cumulative incidence of progression of 2.9% per year during the first 5years of follow-up. Similar incidences have been reported in other studies of glaucoma at different stages of severity.

Relationship between Oxidative Stress Biomarkers and Visual Field Progression in Patients with Primary Angle Closure Glaucoma.

Purpose To investigate the serum changes of oxidative stress markers and the relationship between these factors and visual field (VF) progression in patients with primary angle closure glaucoma (PACG). Methods A case-control and a prospective cohort study. A total of 94 patients with PACG and 89 normal controls were enrolled. Furthermore, 94 PACG subjects were followed up for at least two years (once every six months). All participants were evaluated for serum levels of superoxide dismutase (SOD), total antioxidant status (TAS), hydrogen peroxide (H2O2), malondialdehyde (MDA), glutathione peroxidase, glutathione reductase, and detailed eye and systematic examination. Binary logistic regression analysis and Cox regression analysis were performed. Results The serum levels of SOD and TAS in the PACG group were significantly lower than those in the control group (p < 0.001). Meanwhile, PACG subjects had significantly higher levels of MDA and H2O2 than the normal control subjects (p < 0.001). Serum levels of TAS (OR = 0.773, 95%CI = 0.349 − 0.714, p < 0.001), SOD (OR = 0.975, 95%CI = 0.955 − 0.995, p < 0.001), MDA (OR = 1.155, 95%CI = 1.080 − 1.235, p < 0.001), and H2O2 (OR = 1.216, 95%CI = 1.142 − 1.295, p < 0.001) were independent risk/protective factors for PACG. TAS levels (HR = 0.041, 95%CI = 0.008–0.218, p < 0.001), SOD levels (HR = 0.983, 95%CI = 0.971–0.994, p = 0.003), and MDA levels (HR = 1.010, 95%CI = 1.001–1.018, p = 0.015) at baseline were associated with visual field progression. Kaplan–Meier curves reveal that patients with TAS < 0.95/SOD < 143/MDA > 12 had a significantly higher percentage of PACG progression (p < 0.05). Conclusions Decreased levels of TAS and SOD as well as increased levels of MDA at baseline were associated with VF progression in patients with PACG. These findings suggest that oxidative stress was involved in the onset and development of PACG.

Association Between Parapapillary Choroidal Vessel Density Measured With Optical Coherence Tomography Angiography and Future Visual Field Progression in Patients With Glaucoma

ImportanceInvestigating the vascular risk factors of glaucoma progression is important to individualize treatment; however, few studies have investigated these factors because the available methods have proven insufficient to evaluate the vascular features of patients with glaucoma. Recently, the advent of optical coherence tomography angiography (OCT-A) allowed both qualitative and quantitative microvascular data to be obtained, to in turn evaluate the perfusion status of different retinal layers.ObjectiveTo determine whether baseline parapapillary choroidal vessel density (VD) as measured by OCT-A was associated with future glaucoma progression.Design, Setting, and ParticipantsA prospective, observational, comparative study was conducted at Seoul St Mary’s Hospital of The Catholic University of Korea from March 1, 2016, to December 31, 2018, for 108 glaucomatous eyes in which the retinal nerve fiber layer thickness and mean deviation were measured by at least 5 serial OCT and visual field (VF) examinations. The participants underwent OCT-A at baseline. Vessel density was measured using the en face image of the choroidal map of OCT-A within the β-zone parapapillary atrophy region.Main Outcomes and MeasuresParapapillary choroidal VD, retinal nerve fiber layer thinning rate, mean deviation rate, and progression of glaucoma as measured by OCT and VF.ResultsAmong 108 patients (74 women and 34 men; mean [SD] age, 59.2 [13.1] years), 38 (35.2%) showed progression of glaucoma as measured by OCT and 34 (31.5%) showed progression of glaucoma as measured by VF at the last follow-up. The mean (SD) follow-up duration was 2.6 [2.3] years. The presence of disc hemorrhage (odds ratio, 5.57; 95% CI, 3.18-8.29; P = .001), baseline mean deviation (odds ratio, 0.83; 95% CI, 0.71-0.97; P = .02), and parapapillary choroidal VD (odds ratio, 1.18; 95% CI, 1.09-1.28; P = .01) were associated with progression of glaucoma as measured by VF, but not with progression of glaucoma as measured by OCT. Baseline parapapillary choroidal VD (β, 1.08; 95% CI, 1.02-1.13; P < .001) was associated with progression of glaucoma as measured by VF using Cox proportional hazards regression analysis.Conclusions and RelevanceThese data suggest that lower parapapillary choroidal VD within the β-zone parapapillary atrophy at baseline among individuals with glaucoma could play some role in the risk of progression of glaucoma as measured by VF. The findings suggest that patients with glaucoma with lower parapapillary choroidal VD within the β-zone parapapillary atrophy at baseline warrant careful monitoring for progression of glaucoma as measured by VF.

The association between corneal biomechanical parameters and visual field progression in patients with normal tension glaucoma

Objective: To evaluate the association between corneal biomechanical parameters and visual field (VF) progression in normal tension glaucoma (NTG) using the Corvis-ST device, and to evaluate the ability of corneal biomechanical parameters to predict the VF progression. Methods: Corneal biomechanical parameters of newly diagnosed NTG patients were obtained using Corvis-ST in the baseline follow-up visit. The VF progression was defined as a 4-point increase in the Advanced Glaucoma Intervention Study (AGIS) score compared to the baseline in three consecutive follow-up visits (per 3-6 months). Corneal biomechanical parameters were compared between progressive and nonprogressive VF loss eyes using the independent-sample t test and Mann-Whitney U test. Spearman correlation analysis was used to explore the relationship between the corneal biomechanical parameters and the VF progression. Receiver operating characteristic curves were studied for the parameters and the sensitivity and specificity for distinguishing between progressive and nonprogressive glaucomatous eyes. The areas under the receiver operating characteristic curves (AUC) were also evaluated. Results: Sixty patients with NTG were enrolled in this study. Among them, 12 were lost to follow-up. A total of 48 patients completed all follow-up visits on schedule. Eleven of them were excluded due to one or more uncontrolled intraocular pressure (IOP) during the follow-up (less than 30% IOP reduction from the baseline). Thirty-seven eyes of 37 diagnosed NTG patients were enrolled. Ten eyes reached a progression endpoint. There was no significant difference in age, central corneal thickness, axial length, baseline IOP or baseline VF between the two groups. There was significant difference in Time A1 [(7.10±0.17) ms vs. (7.37±0.28) ms, t=-3.357, P=0.002], Length A1 [1.74(1.61, 1.77) mm vs. 1.78(1.77, 1.79) mm, Z=-3.036, P=0.002], Velocity A1 [0.16(0.14, 0.16) m/s vs. 0.15(0.14, 0.15) m/s, Z=-2.627, P=0.009] and DefAmpl HC [(1.22±0.13) mm vs. (1.12±0.11) mm, t=2.601, P=0.013] between progressive and nonprogressive glaucomatous eyes. Correlation analysis showed that Time A1, Length A1, Velocity A1 and DefAmpl HC were correlated with VF progression (r=-0.521, -0.463, 0.401, 0.349, P<0.05) . Time A1 demonstrated the highest AUC (0.817, P=0.001), followed by Length A1 (0.780, P=0.003), Velocity A1 (0.734, P=0.012) and DefAmpl HC (0.713, P=0.022). The cut-off set of Time A1 was 7.2 ms, the sensitivity was 80.0%, and the specificity was 82.8%. Conclusions: There were differences in corneal biomechanical parameters between eyes with progressive and nonprogressive VF loss in patients with NTG. There were lower Time A1 and Length A1 values and higher Velocity A1 and DefAmpl HC values in progressive glaucomatous eyes. This indicates a quicker response to reach first degree applanation and a larger degree of corneal deformability in progressive eyes. It is predicted that the easier deforming of the cornea, the smaller tolerance of the sclera and lamina cribros on IOP, making the optic disc more vulnerably. This may be one of the causes of glaucomatous optic nerve damage. Time A1 was the best parameter to predict the progression of VF among the corneal biomechanical parameters obtained by Corvis-ST. (Chin J Ophthalmol, 2018, 54: 171-176).

The Effective Dynamic Ranges for Glaucomatous Visual Field Progression With Standard Automated Perimetry and Stimulus Sizes III and V.

PurposeIt has been shown that threshold estimates below approximately 20 dB have little effect on the ability to detect visual field progression in glaucoma. We aimed to compare stimulus size V to stimulus size III, in areas of visual damage, to confirm these findings by using (1) a different dataset, (2) different techniques of progression analysis, and (3) an analysis to evaluate the effect of censoring on mean deviation (MD).MethodsIn the Iowa Variability in Perimetry Study, 120 glaucoma subjects were tested every 6 months for 4 years with size III SITA Standard and size V Full Threshold. Progression was determined with three complementary techniques: pointwise linear regression (PLR), permutation of PLR, and linear regression of the MD index. All analyses were repeated on “censored'' datasets in which threshold estimates below a given criterion value were set to equal the criterion value.ResultsOur analyses confirmed previous observations that threshold estimates below 20 dB contribute much less to visual field progression than estimates above this range. These findings were broadly similar with stimulus sizes III and V.ConclusionsCensoring of threshold values < 20 dB has relatively little impact on the rates of visual field progression in patients with mild to moderate glaucoma. Size V, which has lower retest variability, performs at least as well as size III for longitudinal glaucoma progression analysis and appears to have a larger useful dynamic range owing to the upper sensitivity limit being higher.

Prediction of Visual Field Progression in Patients with Primary Open-Angle Glaucoma, Mainly Including Normal Tension Glaucoma

An objective method to predict individual visual field progression will contribute to realise personalised medication. The purpose of this study was to establish a predictive formula for glaucomatous visual field progression in patients with Primary open-angle glaucoma, mainly including normal tension glaucoma. This study was a large-scale, longitudinal and retrospective study including 498 eyes of 312 patients visiting from June 2009 to May 2015. In this analysis, 191 eyes of 191 patients meeting all eligible criteria were used. A predictive formula to calculate the rate of glaucomatous visual field progression (mean deviation slope) was obtained through multivariate linear regression analysis by adopting “Angle of Retinal Nerve Fibre Layer Defect” at the baseline, “Vertical Cup-Disc ratio” at the baseline, “Presence or absence of Disc Haemorrhage” during the follow-up period, and “Mean IOP change (%)” during the follow-up period as predictors. Coefficient of determination of the formula was 0.20. The discriminative ability of the formula was evaluated as moderate performance using receiver operating characteristic analysis, and the area under the curve was approximately 0.75 at all cut-off values. Internal validity was confirmed by bootstrapping. The predictive formula established by this type of approach might be useful for personalised medication.

Change in Visual Field Progression Following Treatment Escalation in Primary Open-angle Glaucoma

To evaluate the effect of treatment escalation on the rate of visual field progression in patients with primary open-angle glaucoma (POAG). Multicenter database study. We reviewed the electronic records of 171 patients with POAG under medical hypotensive treatment who underwent 5 consecutive visits 6 months apart before and after medical treatment escalation or additive laser trabeculoplasty. We calculated the rate of visual field progression (mean deviation change per year) before and after treatment escalation. The mean duration of follow-up was 5.1±0.5 years and the mean number of visual field examinations was 10.2±0.2. In 139 eyes with medical treatment escalation, the rate of progression was significantly reduced [from -0.57 to -0.29 dB/y; P=0.022; intraocular pressure (IOP) reduction 11.1%]. In detail, the rate of progression was significantly reduced after escalation from mono to dual therapy, dual to triple therapy, and from mono to triple therapy (-0.35 to -0.24 dB/y, P=0.018; -1.01 to -0.48 dB/y, P=0.038; -1.04 to -0.35 dB/y, P=0.020, respectively). In 32 eyes with additive laser trabeculoplasty, the rate of progression was significantly reduced (-0.60 to -0.24 dB/y; P=0.014; IOP reduction 9.4%). Medical treatment escalation or additive laser trabeculoplasty significantly reduced the rate of visual field progression in POAG. Larger IOP reduction has a greater probability of reducing glaucoma progression.

Investigating the usefulness of a cluster-based trend analysis to detect visual field progression in patients with open-angle glaucoma

Background/aimsTo investigate the usefulness of the Octopus (Haag-Streit) EyeSuite’s cluster trend analysis in glaucoma.MethodsTen visual fields (VFs) with the Humphrey Field Analyzer (Carl Zeiss Meditec), spanning 7.7 years on average...

Visual Field Progression in Patients with Primary Angle-Closure Glaucoma Using Pointwise Linear Regression Analysis

To evaluate visual field (VF) progression and rate of glaucomatous VF loss in patients with primary angle-closure glaucoma (PACG) using pointwise linear regression (PLR) trend analysis. Clinic-based retrospective study. Primary angle-closure glaucoma patients with 5 or more reliable VF tests and with 5 years or more of follow-up. Visual field progression was assessed by PROGRESSOR software version 3.7 (Medisoft, Leeds, United Kingdom) and was defined by the presence of at least 2 adjacent testing points located within the same hemifield that showed progression with a change of -1 dB/year or more (P < 0.01) for inner points or -2 dB/year or more (P < 0.01) for edge points. We also performed a logistic regression analysis to determine the variables associated with rapid progression (defined as mean slope of progressing points ≥-1.5 dB/year). Visual field progression and rate of VF loss. Of the 1296 patients who were assessed, 398 (30.7%) fulfilled the inclusion criteria of 5 or more VFs and 5 years or more of follow-up. Visual field progression was observed in 63 of 398 eyes (15.8%) according to the PLR criteria. The overall mean rate of VF change for these patients was -0.12±0.51 dB/year over a mean follow-up period of 10.4±3.7 years. There were no significant differences in the age, gender distribution, follow-up duration, or number of VFs between those who showed progression and those who did not (all P > 0.05). The most common sector of VF progression was the superior arcuate area (65%). Rapid progression was found in 36 patients (57%). Multiple logistic regression analysis revealed older age and higher vertical cup-to-disc ratio (VCDR) at presentation as predictors of rapid progression (all P < 0.005) in the progressing group (n= 63). In patients with PACG being managed in a hospital setting, VF progression was noted in 15.8%, and the overall rate of VF loss was -0.12±0.51 dB/year. The superior arcuate was the most common sector of progression. Older age and higher VCDR at presentation were associated with rapid progression.

Visual Field Progression is Associated with Systemic Concentration of Macrophage Chemoattractant Protein-1 in Normal-Tension Glaucoma

ABSTRACTPurpose: To investigate the associations between endothelin-1 (ET-1) and macrophage chemoattractant protein-1 (MCP-1) levels and visual field (VF) progression in normal-tension glaucoma (NTG).Methods: We conducted a prospective, longitudinal study in 71 patients with NTG. Blood samples from all subjects were assayed for ET-1 and MCP-1 concentrations, and baseline ophthalmic examinations, including the VF, were performed. Baseline data were compared with follow-up data over 3 years.Results: After 3 years of follow-up, 14 of the 71 patients showed VF progression, and the systemic MCP-1 level was significantly associated with VF progression (r = 0.318, p = 0.007). Multiple regression analysis showed that VF progression was significantly associated with MCP-1 (odds ratio, OR = 1.021, 95% CI = 1.003–1.040; p = 0.020) and optic disc hemorrhage (ODH; OR = 1.573; 95% CI = 1.140–2.170; p = 0.023).Conclusions: Systemic MCP-1 levels were associated with VF progression in patients with NTG.

Retrobulbar Hemodynamics and Visual Field Progression in Normal Tension Glaucoma: A Long-Term Follow-Up Study.

Purpose. Vascular risk factors are important factors in the pathogenesis of glaucoma. The purpose of this research was to investigate retrobulbar hemodynamics and visual field progression in patients with normal tension glaucoma (NTG). Patients and Methods. 31 eyes of 16 patients with NTG were included in a retrospective long-term follow-up study. Colour Doppler imaging was performed at baseline to determine various CDI parameters in the different retrobulbar vessels. The rate of visual field progression was determined using the Visual Field Index (VFI) progression rate per year (in %). To be included in the analysis, patients had at least 4 visual field examinations with a follow-up of at least 2 years. Results. Mean follow-up was 7.6 ± 4.1 years with an average of 10 ± 5 visual field tests. The mean MD (mean defect) at baseline was −7.61 ± 7.49 dB. The overall VFI progression was −1.14 ± 1.40% per year. A statistical significant correlation between VFI progression and the RI of the NPCA and PSV of the CRA was found. Conclusion. Long-term visual field progression may be linked to impaired retrobulbar hemodynamics in patients with NTG only to a limited degree. Interpretation of the data for an individual patient seems to be limited due to the variability of parameters.

Effect of cataract extraction on the visual field decay rate in patients with glaucoma.

A visual field parameter that is resistant to cataract formation and extraction would help monitor glaucomatous visual field progression in patients with coexisting glaucoma and cataract. To evaluate the effect of cataract surgery on the slow and fast components of visual field decay in a group of patients with glaucoma. Retrospective, interventional, longitudinal study. Eighty-five eyes of 68 patients with open-angle glaucoma who had cataract extraction were included. All patients had 5 or more reliable visual field measurements before and after surgery. A pointwise exponential regression was used to perform trend analysis on thresholds at visual field test locations before and after cataract surgery. The test locations were ranked according to the decay rate and were partitioned into slow and fast groups. The slow and fast visual field rate components were measured before and after cataract surgery and were compared. Linear regressions of the mean deviation and the visual field parameter were performed against time and were compared before and after surgery. The mean (SD) mean deviation was -5.5 (5.1) dB before cataract surgery and -5.0 (4.9) dB after cataract surgery (P = .002). The mean (SD) Visual Field Index was 86.4% (13.5%) before cataract surgery and 86.6% (13.3%) after cataract surgery (P = .30). The mean (SD) slow component rate decreased from 0.48% (0.73%) per year before surgery to 0.26% (0.42%) per year after surgery (P = .04). No statistically significant difference was identified in the fast component mean (SD) rate per year before surgery (3.37% [4.05%]) vs per year after surgery (3.46% [3.56%]) (P = .29). Cataract progression seems to be the main determinant for the slow visual field rate component and does not change the fast visual field rate component. We conclude that the method used can help reduce the confounding effects of cataract progression and cataract extraction on measured perimetric progression in glaucoma.

The effect of medical therapy on IOP control in Ghana.

To investigate IOP control following twelve months of continuous medical therapy in Ghana. This retrospective case series included 163 glaucoma patients diagnosed at a referral eye center between 1996 and 2006. Information collected included age, gender, IOP at presentation, six months and one year post treatment and types of anti-glaucoma medications prescribed. Optimal IOP control was defined according to results from the Advanced Glaucoma Intervention Study (AGIS), which demonstrated arrest of visual field progression in patients with IOP < 18 mmHg at all visitations: Level 1 (post-treatment IOP ≤ 21 mmHg); Level 2 (≤ 18 mmHg) and level 3 (≤ 16 mmHg). The principal outcome measure was the achievement of IOP <18 mmHg at six months and twelve month visitations. One hundred sixty three patients were analyzed. These included 68 males (41.7%) and 95 females (58.3%). The mean age was 57±16 (median 59 years; range 7 - 95 years). There was no significant difference in age (p=0.35) or mean IOP (p=0.08) between genders. The mean pre-treated IOP of 31.9±8.9 mmHg significantly decreased to 21.3±6.6 mmHg at 6 months (p=0.001), with 57.4% of eyes at Level 1 IOP control, 25.3% at Level 2 and 15.4% at Level 3 and decreased further at 12 months to 20.7±6.9 mmHg (p=0.48) with 69.7% of eyes at Level 1, 34.4% at Level 2, and 12.4% at Level 3. Current medical regimen is insufficient to reduce IOP to target levels as defined in the Advanced Glaucoma Intervention Study.

Effect of dorzolamide/timolol combination on the visual field in glaucoma.

PurposeTo evaluate the effect of treatment for 3 years with a dorzolamide/timolol (1%/0.5%) fixed combination (DTFC) on visual field progression in patients with open-angle glaucoma.ParticipantsA total of 14 consecutive patients were enrolled who had been previously treated with monotherapy or any combination of a beta blocker, carbonic anhydrase inhibitor, and/or prostaglandin analog for primary open-angle glaucoma (POAG; n=4) or normal-tension glaucoma (NTG; n=10).MethodsPatients were switched to DTFC from their prior glaucoma therapy. The IOP was measured at intervals of 4–6 weeks, and the visual fields were examined at least twice a year for 3 years. The annual change of mean deviation (MD slope) was used to quantify visual field loss.ResultsThe mean MD value was −5.9±5.0 dB at baseline; it was −5.6±4.8 dB at 12 months, −5.9±5.0 dB at 24 months, and −5.6±5.1 dB at 36 months after switching. The mean MD slope was −0.2±0.8 dB/year before switching and 0.3±1.3 dB/year from baseline to 1 year, −0.3±1.1 dB/year from 1–2 years, and 0.3±0.9 dB/year from 2–3 years after switching. The mean MD slope from baseline to 36 months was correlated with the IOP reduction rate at 36 months after switching. Visual field progression was associated with the IOP reduction rate at 12 months after switching.ConclusionSwitching to DTFC from prior glaucoma therapy improved the MD slope for at least 3 years. Reduction of the IOP after switching to DTFC was effective for delaying visual field progression. Although our study was not nonrandomized and was small in scale, the findings suggest that DTFC might have a beneficial effect on the visual fields in patients with open-angle glaucoma.