Fast Central Visual Field Progression in Patients With Normal-Tension Glaucoma and Nocturnal Blood Pressure Dip.

PURPOSE

This study aimed to investigate the relationship between nocturnal blood pressure (BP) dip and rapid central visual field (VF) progression in patients with early-to-moderate stage normal-tension glaucoma (NTG).

DESIGN

Prospective cohort study

PARTICIPANTS

In total, 199 untreated NTG patients participated in this study.

METHODS

In total, 199 untreated NTG patients underwent 24-h ambulatory BP monitoring (ABPM) in their habitual position, with a minimum 2-year follow-up. Patients were classified as non-dippers, dippers, and over-dippers based on their nocturnal BP dip. The rates of central VF changes over time among these groups were compared using linear mixed model analysis. Fast central VF progression was defined as a decline in the mean total deviation (MTD10) values of 12 central points at a rate of < -0.5 dB/year. Logistic regression analysis identified clinical factors, including nocturnal BP dip, that contribute to accelerated central VF progression.

MAIN OUTCOME MEASURES

Rate of central VF progression and prevalence of fast central VF progression

RESULTS

Over-dippers showed a significantly faster rate of central VF progression than non-dippers and dippers, as indicated by the MTD10 decline over an average follow-up of 4.9 years (non-dippers: -0.23 dB/year; dippers: -0.27 dB/year; over-dippers: -0.53 dB/year; P = .007). The prevalence of fast central VF progression was significantly higher in over-dippers (non-dippers: 19.8%; dippers: 23.5%; over-dippers: 60.0%; P < .001). A higher percentage of nocturnal mean arterial pressure (MAP) dip was identified as a significant risk factor for fast central VF progression (odds ratio: 1.062, P < .05).

CONCLUSIONS

Patients with NTG classified as over-dippers showed significantly faster central VF progression than non-dippers and dippers, with over 50% of over-dippers experiencing fast progression. Rapid central VF progression was significantly associated with the percentage of nocturnal MAP dip in eyes with early-to-moderate stage NTG. These findings highlight the importance of closely monitoring central VF changes in NTG patients with pronounced nocturnal BP dips to prevent functional impairment caused by rapid central VF loss.