J GlaucomaNovember 20199 citations

Baseline Central Visual Field Defect as a Risk Factor For NTG Progression: A 5-Year Prospective Study.

Raman Puspha, Suliman Nurull B, Zahari Mimiwati, Mohamad Nor Fadhilah, Kook Michael S, Ramli Norlina

View on PubMed DOI: 10.1097/IJG.0000000000001359

AI Summary

NTG patients with baseline central visual field defects progressed significantly faster than those with peripheral defects, indicating central involvement is a key risk factor for worsening glaucoma.

Abstract

Precis: This 5-year follow-up study on normal-tension glaucoma (NTG) patients demonstrated that those with baseline central visual field (VF) defect progress at a more increased rate compared with those with peripheral field defect.

Purpose

The purpose of this study was to investigate the clinical characteristics, including 24-hour ocular perfusion pressure and risk of progression in patients with baseline central VF defect, as compared with those with peripheral VF defect in NTG.

Design

This was a prospective, longitudinal study.

Methods

A total of 65 NTG patients who completed 5 years of follow-up were included in this study. All the enrolled patients underwent baseline 24-hour intraocular pressure and blood pressure monitoring via 2-hourly measurements in their habitual position and had ≥5 reliable VF tests during the 5-year follow-up. Patients were assigned to two groups on the basis of VF defect locations at baseline, the central 10 degrees, and the peripheral 10- to 24-degree area. Modified Anderson criteria were used to assess global VF progression over 5 years. Kaplan-Meier analyses were used to compare the elapsed time of confirmed VF progression in the two groups. Hazard ratios for the association between clinical risk factors and VF progression were obtained by using Cox proportional hazards models.

Results

There were no significant differences between the patients with baseline central and peripheral VF defects in terms of demography, clinical, ocular and systemic hemodynamic factors. Eyes with baseline defects involving the central fields progressed faster (difference: βcentral=-0.78 dB/y, 95% confidence interval=-0.22 to -1.33, P=0.007) and have 3.56 times higher hazard of progressing (95% confidence interval=1.17-10.82, P=0.025) than those with only peripheral defects.

Conclusion

NTG patients with baseline central VF involvement are at increased risk of progression compared with those with peripheral VF defect.

MeSH Terms

AdultArterial PressureBlood PressureDisease ProgressionFemaleFollow-Up StudiesHumansIntraocular PressureLow Tension GlaucomaMaleMiddle AgedOptic DiskProportional Hazards ModelsProspective StudiesRisk FactorsTonometry, OcularVision DisordersVisual Field TestsVisual Fields

Shields Classification

Ch. 5Assessment of Visual Fields

Ch. 9Clinical Epidemiology of Glaucoma

Ch. 11Chronic Open-Angle Glaucoma and Normal Tension Glaucoma

Key Concepts6

Normal-tension glaucoma (NTG) patients with baseline central visual field (VF) defect progressed at a more increased rate compared with those with peripheral field defect over a 5-year follow-up period.

PrognosisCohortProspective Cohort Studyn=65 NTG patientsCh6Ch12

Eyes of normal-tension glaucoma (NTG) patients with baseline defects involving the central visual fields progressed faster (difference: ̢central=-0.78 dB/y, 95% confidence interval=-0.22 to -1.33, P=0.007) and had 3.56 times higher hazard of progressing (95% confidence interval=1.17-10.82, P=0.025) than those with only peripheral defects over 5 years.

PrognosisCohortProspective Longitudinal Studyn=65 NTG patientsCh6Ch12

There were no significant differences between normal-tension glaucoma (NTG) patients with baseline central and peripheral visual field defects in terms of demography, clinical, ocular, and systemic hemodynamic factors.

DiagnosisCohortProspective Longitudinal Studyn=65 NTG patientsCh12

Modified Anderson criteria were used to assess global visual field progression over 5 years in normal-tension glaucoma (NTG) patients.

MethodologyCohortProspective Longitudinal Studyn=65 NTG patientsCh6

Kaplan-Meier analyses were used to compare the elapsed time of confirmed visual field progression in normal-tension glaucoma (NTG) patients with baseline central versus peripheral visual field defects.

MethodologyCohortProspective Longitudinal Studyn=65 NTG patientsCh6Ch10

Hazard ratios for the association between clinical risk factors and visual field progression in normal-tension glaucoma (NTG) patients were obtained using Cox proportional hazards models.