Disc haemorrhage, long-term IOP fluctuation predict glaucoma progression
Long-term intraocular pressure (IOP) fluctuation, greater vertical cup-to-disc ratio (v-C/D), and the presence or history of disc haemorrhage (DH) are significantly associated with progression of normal-tension glaucoma (NTG), suggests a study involving Japanese patients.
Ninety patients (mean age, 53.9 years; baseline IOP, 12.3 mm Hg; mean deviation [MD], –2.8 dB) were included in the analysis. MD slope showed an average of –0.33 dB/year (median, –0.23, 95 percent CI, –0.44 to –0.22).
At 5 years, glaucoma progression probability stood at 66 percent (55–78), as defined by visual field (VF) deterioration or disc/peripapillary retina deterioration (criterion 1); 52 percent (37–60), as defined by VF deterioration (criterion 2); and 50 percent (38–71), as defined by disc/peripapillary retina deterioration (criterion 3).
Presence or history of DH (p<0.001), long-term IOP fluctuation (p=0.020), and a greater v-C/D (p=0.018) significantly contributed to NTG progression defined by criterion 1. Long-term IOP fluctuation (p=0.011) and a greater v-C/D (p=0.036) significantly predicted progression defined by criterion 2. For criterion 3, long-term IOP fluctuation (p=0.022) and presence or history of DH (p=0.0018) were significant predictors for progression.
This prospective 5-year study included NTG patients with IOP consistently ≤15 mm Hg without treatment at baseline. The authors performed VF examinations every 3 months and took photos of disc/peripapillary retina every 6 months. Patients were followed up without treatment.
Deterioration in VF was defined by reference to Guided Progression Analysis Software of the Humphrey VF Swedish Interactive Thresholding Algorithm 24-2 and disc/peripapillary retina deterioration as adjudged by three independent observers.
The authors assessed the time to disease progression, as defined by VF or deterioration of the optic nerve head structure, using life table analysis. They also identified the risk factors for NTG progression by using the Cox proportional hazards model.