Differences in Factors Associated With Glaucoma Progression With Lower Normal Intraocular Pressure in Superior and Inferior Halves of the Optic Nerve Head.
Asaoka Ryo, Sakata Rei, Yoshitomi Takeshi, Iwase Aiko, Matsumoto Chota, Higashide Tomomi, Shirakashi Motohiro, Aihara Makoto, Sugiyama Kazuhisa, Araie Makoto
AI Summary
This NTG study found different risk factors for progression in superior (IOP fluctuation) and inferior (BMI, myopia, cup-to-disc, disc hemorrhage) optic nerve halves, guiding tailored management.
Abstract
Purpose
The purpose of this study was to investigate risk factors for progression in the superior and inferior hemi-visual fields (hemi-VFs) and the corresponding hemi-disc/retinas in eyes with normal tension glaucoma (NTG).
Methods
A 5-year prospective follow-up of 90 patients with NTG with untreated intraocular pressure (IOP) consistently ≤ 15 mm Hg was conducted. The IOP and Humphrey Perimeter measurements and disc/retina stereo-photographs were taken every 3 and 6 months, respectively. Risk factors for progression in the superior and inferior hemi-VFs and in the superior and inferior hemi-disc/retinas were investigated.
Results
The mean total deviation values decreased at -0.50 ± 0.76 and -0.13 ± 0.34 dB/year in the superior and inferior hemi-VFs, respectively (P < 0.001). In the superior hemi-VF, the risk factor for faster progression was greater long-term IOP fluctuation (P = 0.022). In the inferior hemi-VF, the risk factors were disc hemorrhage (DH), greater myopic refraction, body mass index (BMI), and vertical cup-to-disc ratio (v-C/D; P < 0.05). The progression probability was 47.7 ± 6.0 and 17.7 ± 4.7% at 5 years in the superior and inferior hemi-disc/retinas respectively (P < 0.001), and DH was a risk factor for progression in both (P = 0.001).
Conclusions
In NTG eyes, greater BMI, myopia, and v-C/D are characteristic risk factors for faster progression in the superior half of the optic nerve head (ONH), whereas long-term IOP fluctuation is the significant risk factor in the inferior half of the ONH, whereas DH is a risk factor in both.
Translational relevance: Different risk factors were identified in superior and inferior hemifields in NTG eyes.
MeSH Terms
Shields Classification
Key Concepts5
In a 5-year prospective follow-up of 90 patients with normal tension glaucoma (NTG) with untreated intraocular pressure (IOP) consistently ≤ 15 mm Hg, the mean total deviation values decreased at -0.50 0.76 dB/year in the superior hemi-visual fields (hemi-VFs) and -0.13 0.34 dB/year in the inferior hemi-VFs, with a statistically significant difference (P < 0.001).
In a 5-year prospective follow-up of 90 patients with normal tension glaucoma (NTG) with untreated intraocular pressure (IOP) consistently ≤ 15 mm Hg, greater long-term IOP fluctuation was identified as a risk factor for faster progression in the superior hemi-visual field (P = 0.022).
In a 5-year prospective follow-up of 90 patients with normal tension glaucoma (NTG) with untreated intraocular pressure (IOP) consistently ≤ 15 mm Hg, disc hemorrhage (DH), greater myopic refraction, body mass index (BMI), and vertical cup-to-disc ratio (v-C/D) were identified as risk factors for faster progression in the inferior hemi-visual field (P < 0.05).
In a 5-year prospective follow-up of 90 patients with normal tension glaucoma (NTG) with untreated intraocular pressure (IOP) consistently ≤ 15 mm Hg, the progression probability was 47.7 6.0% and 17.7 4.7% at 5 years in the superior and inferior hemi-disc/retinas respectively (P < 0.001), and disc hemorrhage (DH) was a risk factor for progression in both (P = 0.001).
In normal tension glaucoma (NTG) eyes, greater body mass index (BMI), myopia, and vertical cup-to-disc ratio (v-C/D) are characteristic risk factors for faster progression in the superior half of the optic nerve head (ONH), whereas long-term intraocular pressure (IOP) fluctuation is the significant risk factor in the inferior half of the ONH, and disc hemorrhage (DH) is a risk factor in both.
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