Comparison of corneal biomechanics among primary open-angle glaucoma with normal tension or hypertension and controls / 中华医学杂志(英文版)

BACKGROUND@#Normal tension glaucoma (NTG) is a less pressure-dependent type of glaucoma with characteristic optic neuropathy. Recently, the biomechanical mechanism has been thought to account for glaucomatous optic neuropathy to some degree. We intended to compare dynamic corneal response parameters (DCRs) among patients with primary open-angle glaucoma with normal tension or hypertension and controls. The correlations between DCRs and known risk factors for glaucoma were also analyzed.@*METHODS@#In this cross-sectional study, 49 NTG subjects, 45 hypertension glaucoma (HTG) subjects, and 50 control subjects were enrolled. We compared the differences in DCRs using corneal visualization Scheimpflug technology among the NTG, HTG, and control groups. We also analyzed the correlations between DCRs and known risk factors for glaucoma (eg, central corneal thickness [CCT], intraocular pressure [IOP], etc).@*RESULTS@#The maximum inverse concave radius (NTG: 0.18 [0.17, 0.20] mm-1; control: 0.17 [0.16, 0.18] mm-1; P = 0.033), deformation amplitude ratio of 2 mm (DAR 2 mm, NTG: 4.87 [4.33, 5.39]; control: 4.37 [4.07, 4.88]; P  0.05). In the univariate and multivariate analyses, some of the DCRs, such as IR, were negatively correlated with CCT and IOP, whereas SP-A1 was positively correlated with CCT and IOP.@*CONCLUSIONS@#The cornea was more deformable in NTG than in HTG or controls. There were no significant differences in corneal deformability between HTG and controls. The cornea was more deformable with the thinner cornea and lower IOP.

The Difference in Intraocular Pressure before and after Visual Field Test Measured by Rebound Tonometer

PURPOSE: To investigate the effect of a visual field (VF) test on intraocular pressure (IOP) and relevant parameters in a normal group and an open-angle glaucoma group, and to determine the appropriate time of IOP measurements.METHODS: The IOP was measured by a rebound tonometer before and after a VF test for the normal, normal-tension glaucoma, and high-tension glaucoma groups, and IOP differences after the VF tests were compared among groups. Parameters including age, sex, axial length, central corneal thickness, IOP before the VF test, the VF index, mean deviation, VF test duration, and usage of IOP lowering medications were investigated, and the correlations of these parameters with IOP changes after VF tests were determined using linear regression analyses.RESULTS: A total of 232 participants (232 eyes) included 55 normal subjects, 131 normal-tension glaucoma patients, and 46 high-tension glaucoma patients. The IOP differences after VF tests were not statistically significant in the normal and high-tension glaucoma groups, and the difference was 0.31 mmHg in the normal-tension glaucoma group (p = 0.013). Multivariate regression analyses revealed that axial length (p = 0.005) and IOP before the VF test (p < 0.001) were relevant factors in the total number of patients, and the axial length (p = 0.017), IOP before the VF test (p = 0.001), and duration (p = 0.029) were found to be significantly associated with IOP differences in the normal-tension glaucoma group.CONCLUSIONS: The IOP changes after VF tests using the rebound tonometer were significant in the normal-tension glaucoma group, but were within an acceptable range. The IOP value measured after a VF test is clinically valid in clinical practice.

Internal carotid artery aneurysm mimicking normal-tension glaucoma / Aneurisma de carótida interna simulando glaucoma de pressão normal

ABSTRACT Differentiating glaucomatous from nonglaucomatous optic disc cupping remains challenging. We present a case of a 48-year-old woman with an internal carotid aneurysm of approximately 3.5 mm × 6.5 mm that mimicked normal-tension glaucoma. The patient had a 2-year history of low vision acuity in her left eye and frontal oppressive headache. Owing to the carotid aneurysm, she developed an asymmetric vertical cup-to-disc ratio above 0.2, and marked inferotemporal neuronal rim loss and pallor of the residual rim were noted in the left disc. She also developed a visual field defect with an arcuate scotoma in the left eye. The patient was referred to a neurosurgeon and underwent endovascular aneurysm occlusion. This case highlights the diagnostic importance of recognizing that many neurological defects remain underdiagnosed.

RESUMO diferenciação de escavações glaucomatosas e não glaucomatosas ainda permanece um desafio ainda nos dias de hoje. Nos descrevemos um caso de aneurisma de carótida interna medindo 3.5mm x 6.5mm que simulava um glaucoma de pressão normal. O caso é sobre uma paciente feminino de 48 anos com história de 2 anos de baixa acuidade visual no olho esquerdo e cefaléia frontal. Devido ao aneurisma de carótida a paciente desenvolveu uma assimetria de escavação vertical maior que 0.2 no olho esquerdo em relação ao direito com defeito localizado da camada de fibras nervosas temporal inferior. Ela também apresentava um defeito arqueado temporal superior a esquerda, cruzando a linha média vertical consistente. Após o diagnostico confirmado pela ressonância magnética funcional, a paciente foi enviada para o neurocirurgião para realização de uma oclusão endovascular do aneurisma. Esse caso nos alerta da importância de se lembrar que não apenas o glaucoma gera escavações suspeitas no disco óptico e que ainda muitos defeitos por causas neurológicas são subdiagnosticados.

The Effect of a Fixed Combination of 0.0015% Tafluprost-0.5% Timolol in Normal Tension Glaucoma Patients

PURPOSE: This study evaluated the effect of a fixed combination of 0.0015% tafluprost-0.5% timolol (Tapcom®, Santen, Osaka, Japan) in glaucoma patients. METHODS: This study included 23 patients who were diagnosed with normal tension glaucoma and treated with a fixed combination of 0.0015% tafluprost-0.5% timolol as the first therapy. Diurnal intraocular pressure (IOP) was measured every 2 and 0.5 hours between 9:00 am and 4:30 pm. The IOP change with respect to body position (positional IOP) was measured at baseline and at 6 months after eye-drop instillations. IOP fluctuation was defined as the standard deviation of IOP measurements. Throughout the study, all side effects were recorded and monitored by the investigators. RESULTS: The mean reduction in IOP in the 0.0015% tafluprost-0.5% timolol fixed combination-treated eyes was −3.37 ± 2.39 mmHg (−19.70 ± 13.97%) for the right eye and −3.22 ± 2.27 mmHg (-18.81 ± 13.28%) for the left eye (paired t-test, p < 0.001). The mean positional IOP measured at 4 pm at 6 months after 0.0015% tafluprost-0.5% timolol fixed combination instillation showed statistically significant reduction from the mean positional IOP at baseline. There was a significant difference in the number of patients with ≤3 mmHg IOP variation over four time points between baseline and at 6 months in the 0.0015% tafluprost-0.5% timolol fixed combination-treated eyes (McNemar test, p < 0.001). There was no serious adverse event causing ocular damage. CONCLUSIONS: Use of 0.0015% tafluprost-0.5% timolol fixed combination was effective and well tolerated in reducing IOP and in maintaining its effectiveness in glaucoma patients.

Clinical Effectiveness of a Brinzolamide 1%-Brimonidine 0.2% Fixed Combination for Normal Tension Glaucoma in South Koreans

PURPOSE: This study evaluated the efficacy and safety of a brinzolamide 1%-brimonidine 0.2% fixed combination (BBFC) for normal tension glaucoma (NTG) in a South Korean population. METHODS: This study included 45 patients who were newly diagnosed with NTG and treated with BBFC as the first therapy from January 2016 through December 2016. The unilateral eye of NTG eyes of all patients were enrolled. If both eyes were eligible, the eye with the more severe glaucomatous change was selected. If the glaucomatous change was similar in both eyes, the right eye was selected. The patients received the BBFC twice a day. Diurnal intraocular pressure (IOP) was measured every 2 and 1/2 hours between 09:00 am and 04:30 pm. The IOP change with respect to body position (positional IOP) was measured at baseline and at 6 months after eyedrop instillation. Throughout the study, all side effects were recorded and monitored by the investigators. RESULTS: Ten patients were excluded due to an allergic reaction or follow-up loss. A total of 35 patients were enrolled in this study. The mean IOP was 15.32 ± 4.00 mmHg at baseline and 13.38 ± 3.30 mmHg at 6 months after BBFC instillation (p < 0.001). The IOP fluctuation decreased from 3.33 ± 3.10 to 2.35 ± 1.40 mmHg after BBFC instillation; however, the difference was not statistically significant (p = 0.150). The mean change in positional IOP showed a statistically significant reduction from 16.94 ± 3.18 to 14.80 ± 3.27 mmHg (p = 0.025). There was no serious adverse drug reaction except in three cases of allergic reaction. CONCLUSIONS: BBFC is effective for the reduction of mean IOP and positional IOP in NTG patients.

Association between Normal-tension Glaucoma and Allergic Rhinitis in a Korean Population-based Study

PURPOSE: The purpose of this study was to investigate the association between normal-tension glaucoma (NTG) and allergic rhinitis in a population-based setting using data from the Korea National Health and Nutrition Exam Survey (2010–2012). METHODS: The authors selected a total of 8,614 participants aged 40 years and older for this study. All participants completed an ophthalmic examination required for diagnosis of NTG based on the International Society for Geographical and Epidemiological Ophthalmology criteria. An interview regarding nasal symptoms was also performed. The included participants were classified into NTG (n = 604) and control (n = 8,010) groups. The authors compared the groups in terms of prevalence of allergic rhinitis and identified risk factors of NTG. RESULTS: In NTG patients, allergic rhinitis prevalence was 29.1% (176/604), which was significantly higher than that of the control group (25.0%, 2,000/8,010; p = 0.023). There were significant associations between NTG and allergic rhinitis (odds ratio [OR]= 1.34, 95% confidence interval [CI] = 1.12–1.62, p = 0.002), even after adjusting for potential confounders (age, sex, diabetes, hypertension, number, of family members, household income quartile, frequency of eating out, and smoking status). In particular, patients with NTG aged 60–69 years, those aged 70–79 years, and those who were male had significantly higher ORs for prior allergic rhinitis compared with control subjects (OR = 1.62, 95% CI = 1.16–2.26, p = 0.005; OR = 1.52, 95% CI = 1.06–2.18, p = 0.024; and OR = 1.42, 95% CI = 1.10–1.83, p = 0.007, respectively). CONCLUSIONS: This study showed a significant association between NTG incidence and allergic rhinitis, especially in males and elderly patients (>60 years of age). These results suggested that allergic rhinitis may have a potential role in the development of NTG. Therefore, ophthalmologists and allergic rhinitis patients should remain vigilant to this potential risk factor.

Corneal Biomechanical Parameters and Asymmetric Visual Field Damage in Patients with Untreated Normal Tension Glaucoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>High intraocular pressure (IOP) and low central corneal thickness (CCT) are important validated risk factors for glaucoma, and some studies also have suggested that eyes with more deformable corneas may be in higher risk of the development and worsening of glaucoma. In the present study, we aimed to evaluate the association between corneal biomechanical parameters and asymmetric visual field (VF) damage using a Corvis-ST device in patients with untreated normal tension glaucoma (NTG).</p><p><b>METHODS</b>In this observational, cross-sectional study, 44 newly diagnosed NTG patients were enrolled. Of these, 31 had asymmetric VF damage, which was defined as a 5-point difference between the eyes according to the Advanced Glaucoma Intervention Study scoring system. Corneal biomechanical parameters were obtained using a Corvis-ST device, such as time from start until the first and second applanation is reached (time A1 and time A2, respectively), cord length of the first and second applanation (length A1 and length A2, respectively), corneal speed during the first and second applanation (velocity A1 and velocity A2, respectively), time from start until highest concavity is reached (time HC), maximum amplitude at the apex of highest concavity (def ampl HC), distance between the two peaks at highest concavity (peak dist HC), and central concave curvature at its highest concavity (radius HC).</p><p><b>RESULTS</b>Time A1 (7.19 ± 0.28 vs. 7.37 ± 0.41 ms, P = 0.010), length A1 (1.73 [1.70-1.76] vs. 1.78 [1.76-1.79] mm, P = 0.007), length A2 (1.58 [1.46-1.70] vs. 1.84 [1.76-1.92] mm, P< 0.001), peak dist HC (3.53 [3.08-4.00] vs. 4.33 [3.92-4.74] mm, P = 0.010), and radius HC (6.20 ± 0.69 vs. 6.59 ± 1.18 mm, P = 0.032) were significantly lower in the worse eyes than in the better eyes, whereas velocity A1 and def ampl HC were significantly higher (0.156 [0.149-0.163] vs. 0.145 [0.138-0.152] m/s, P = 0.002 and 1.19 ± 0.13 vs. 1.15 ± 0.13 mm, P = 0.005, respectively). There was no significant difference in time A2, velocity A2, and time HC between the two groups. In addition, no difference was observed in IOP, CCT, and axial length. In the univariate and multivariate analyses, some of the Corvis-ST parameters, including time A1 and def ampl HC, were correlated with known risk factors for glaucoma, and there was also a significant positive correlation between def ampl HC and age.</p><p><b>CONCLUSIONS</b>There were differences in dynamic corneal response parameters but not IOP or CCT between the paired eyes of NTG patients with asymmetric VF damage. We suggest that the shape of the cornea is more easily altered in the worse eyes of asymmetric NTG patients.</p>

Choroidal Thickness in Thyroid-associated Ophthalmopathy between Normal Tension Glaucoma Using Optical Coherence Tomography

PURPOSE: To compare the macular choroidal thickness in patients with thyroid-associated ophthalmopathy (TAO) with those with normal tension glaucoma (NTG). METHODS: A total of 70 normal eyes, 74 eyes with TAO and 60 eyes with NTG were enrolled in this study. All patients underwent spectral-domain optical coherence tomography (SD-OCT) (Cirrus HD-OCT, Carl Zeiss Meditec Inc., Dublin, CA, USA). Macular choroidal thickness was assessed using enhanced depth imaging. The average macular choroidal thickness was defined as the average value of three measurements: at the fovea and at the points located 1.5 mm in the nasal and temporal directions from the fovea. Generalized estimating equations were used to uncover factors affecting the average macular choroidal thickness. RESULTS: The average, superior and inferior quadrant retinal nerve fiber layer thicknesses were significantly thinner in the NTG group compared with the TAO and control groups (p < 0.001). The average macular choroidal thickness of the TAO group, NTG group and controls was 281.01 ± 60.06 µm, 241.66 ± 55.00 µm and 252.07 ± 55.05 µm, respectively, which were significantly different (p = 0.013). The subfoveal, nasal and temporal side choroidal thicknesses were significantly thinner in the NTG group compared with the TAO group (p = 0.014, 0.012 and 0.034, respectively). Subjects with TAO were associated with a thicker average macular choroidal thickness compared with the NTG group after adjusting for age, sex, spherical equivalent and intraocular pressure (β = 32.61, p = 0.017). CONCLUSIONS: Macular choroidal thickness was significantly thicker in patients with TAO compared with those with NTG. Further evaluation is required to determine if a thick choroid in subjects with TAO has any role in glaucomatous optic neuropathy.

Relationship between Binocular Visual Function and Quality of Life in Bilateral Normal Tension Glaucoma Patients

PURPOSE: To analyze the effect of stereopsis and contrast sensitivity on the quality of life and to evaluate the relationship between integrated binocular visual field (IVF) and binocular visual function in bilateral normal tension glaucoma (NTG) patients. METHODS: Stereopsis and contrast sensitivity tests were performed and compared among 44 NTG patients and 32 normal subjects. The IVF was integrated using the best location method. The correlation between visual function and subscales of the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) was evaluated using univariate linear regression. RESULTS: Stereopsis and contrast sensitivity for the bilateral NTG patients were decreased compared to the normal controls. Stereopsis and contrast sensitivity exhibited a significant correlation with social functions related to vision and color vision among subscales of NEI VFQ-25. IVF mean deviation (MD) and better eye MD showed a significant correlation with stereopsis and contrast sensitivity, while worse eye MD showed no association. CONCLUSIONS: Deterioration of stereopsis and contrast sensitivity in NTG patients affects their quality of life related to social functions and color vision. Both IVF and better eye MDs are correlated with stereopsis and contrast sensitivity in NTG patients.

The Association between Corneal Biomechanical Properties and Initial Visual Field Defect Pattern in Normal Tension Glaucoma

PURPOSE: To investigate the association between corneal biomechanical properties and initial visual field defect pattern in normal tension glaucoma using an Ocular Response Analyzer (ORA; Reichert Instruments, Depew, NY, USA). METHODS: Forty-one patients with normal tension glaucoma were divided into 2 subgroups, 21 patients with initial paracentral scotomas and 20 patients with initial peripheral scotomas. The corneal biomechanical properties of corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), corneal-compensated IOP (IOPcc) measured by the ORA, central corneal thickness, and Goldmann applanation tonometry were comparatively analyzed between the 2 groups. RESULTS: The patients with initial peripheral scotomas were significantly younger than those with initial paracentral scotomas (49.45 ± 13.33 years vs. 58.14 ± 12.49 years, p = 0.035) and showed more myopia (− 2.42 ± 2.22 diopter vs. − 0.89 ± 2.22 diopter, p = 0.034). The mean CRF was significantly lower in the initial paracentral scotoma group than in the initial peripheral scotoma group. (9.45 ± 1.95 mmHg vs. 10.58 ± 2.05 mmHg; p = 0.041). No significant difference in CH, IOPg, or IOPcc was seen between the groups. CONCLUSIONS: CRF was significantly different between the initial paracentral scotoma group and initial peripheral scotoma group in normal tension glaucoma. Thus, CRF may be useful to predict initial central field loss in normal tension glaucoma.

24-hour Ambulatory Blood Pressure in Normal Tension Glaucoma: Associations with Retinal Vessel Diameter and Visual Field Defect Progression

PURPOSE: To investigate the correlation between 24-hour ambulatory blood pressure (BP) monitoring and peripapillary retinal vessel width and visual field (VF) defect progression in normal tension glaucoma (NTG) patients. METHODS: All patients were classified by 24-hour ambulatory BP monitoring as non-dipper (nocturnal dip < 10%) and dipper (nocturnal dip ≥ 10%) group. Vessel diameter, mean deviation (MD) value by VF test and VF progression from Glaucoma Progression Analysis (GPA) were compared among non-dipper and dipper groups. RESULTS: Retinal arterial diameter was wider in the non-dipper group compared to the dipper group (p = 0.015), while retinal venous diameter had no significant relationship between the two groups (p = 0.131). The MD value at baseline and 2 years after was worse in the non-dipper group than the dipper group, respectively (p = 0.006, p = 0.030). But, there was no significant relationship between nocturnal dip and GPA progression (p = 0.658). CONCLUSIONS: There was a statistically significant correlation between nocturnal dips and retinal arterial diameter and MD values. These results suggest that non-invasive fundus photography can predict hemodynamic features like nocturnal dip.

Progression of Visual Field Loss and Body Mass Index in Normal Tension Glaucoma

PURPOSE: To evaluate the association between body mass index (BMI) and visual field (VF) progression in normal tension glaucoma (NTG) patients. METHODS: We reviewed the medical records of 78 eyes of 78 NTG patients who were treated with eye drops for more than 18 months. Age, sex, existence of hypertension (HTN), diabetes mellitus (DM), refractive error, baseline intraocular pressure (IOP), IOP reduction ratio, baseline VF indices including mean deviation (MD) and pattern standard deviation, VF progression rate (MD slope, dB/year), number of eye drops, and BMI were analyzed. The progression of VF was determined by glaucoma change probability analyses (STATPAC 2) using a Humphrey field analyzer. RESULTS: The mean follow-up in consecutive eyes was 4.4 ± 2.7 years. A total of 18 eyes showed progression and 60 eyes did not. The VF progression rate (p 0.05). However, multiple linear regression analyses showed that a lower BMI was significantly associated with faster VF progression in the progression group (β = 0.078; standard error = 0.030; p = 0.027). CONCLUSIONS: In the group in which VF loss progressed despite treatment with eye drops, a lower BMI was associated with progression of VF loss in NTG patients.

Normal-tension glaucoma: an update / Glaucoma de pressão normal: atualização

ABSTRACT Normal-tension glaucoma (NTG) is a progressive optic neuropathy with intraocular pressure (IOP) within the statistically normal range (≤21 mmHg). The prevalence of NTG varies widely among different population studies, being the most prevalent open-angle glaucoma subtype in some reports. The etiology of NTG possibly is multifactorial and still not well defined. Alternative treatments have been proposed based on pathogenesis details. However, in clinical practice, adequate reduction of IOP remains the keystone of managing patients with NTG. We review the pathogenesis of NTG and the available therapies for this optic neuropathy.

RESUMO O glaucoma de pressão normal (GPN) é uma neuropatia óptica progressiva que cursa com a pressão intraocular (PIO) dentro da faixa de normalidade (≤21 mmHg). A prevalência do glaucoma de pressão normal varia entre os estudos populacionais, sendo em alguns o principal subtipo de glaucoma primário de ângulo aberto. A etiologia do glaucoma de pressão normal possivelmente é multifatorial e ainda não foi totalmente esclarecida. Tratamentos alternativos baseados nos diferentes detalhes da patogenia foram recentemente propostos. Entretanto, na prática clínica, a redução adequada da pressão intraocular continua sendo a base do tratamento do glaucoma de pressão normal. O objetivo deste artigo é revisar a patogênese do glaucoma de pressão normal e as formas de terapia disponíveis.

Cognitive performance of primary open-angle glaucoma and normal-tension glaucoma patients / Desempenho cognitivo em pacientes com glaucoma primário de ângulo aberto e glaucoma de pressão normal

ABSTRACT Purpose: To assess cognitive performance differences among primary open-angle glaucoma (POAG) patients, normal-tension glaucoma (NTG) patients, and healthy control (C) subjects. Methods: A total of 60 participants (20 POAG, 20 NTG, and 20 C subjects) were included in this study. A detailed ophthalmologic examination was performed on all participants. A spectral domain-optical coherence tomography (SD-OCT) system was used to measure the ganglion cell-inner plexiform layer (GC-IPL) and retinal nerve fiber layer (RNFL) thicknesses. To assess the cognitive performance of all participants, detailed neurological examinations, including the mini-mental state examination (MMSE), were performed by the same neurologist. Results: There were no significant differences among the groups in terms of age (p =0.348) or gender (p =0.935). The mean RNFL thicknesses were significantly different among the groups (85.2 ± 14.7, 76.8 ± 10.3, and 91.4 ± 7.7 µm in the POAG, NTG, and C subjects, respectively; p <0.001). The mean GC-IPL thicknesses were 77.5 ± 9.7 µm in the POAG group, 73.4 ± 7.8 µm in the NTG group, and 78.8 ± 3.8 µm in the C group. Differences among the groups were not statistically significant (p =0.085). MMSE scores were 26.1 ± 1.4, 25.7 ± 2.3, and 28.8 ± 0.9 in the POAG, NTG, and C groups, respectively. There were significant differences among the three groups (p <0.001). Specifically, there were significant differences between the NTG and C groups (p <0.001), and between the POAG and C groups (p =0.001). There was no significant difference between the POAG and NTG groups (p =0.595). Conclusions: There appear to be similar risk factors in glaucoma and neurodegenerative disorders that cause deterioration in cognitive performance. Comparing the low MMSE scores of the POAG and NTG patients with the scores of healthy C participants supports our hypothesis. Consequently, it is recommended that a neurologist should also examine glaucoma patients.

RESUMO Objetivos: Avaliar as diferenças de desempenho cognitivo entre pacientes com glaucoma primário de ângulo aberto (POAG), glaucoma de pressão normal (NTG) e controle de indivíduos saudáveis (C). Métodos: Um total de 60 pessoas (20 POAG, 20 NTG e 20 indivíduos saudáveis) foram incluídos neste estudo. Um exame oftalmológico detalhado foi realizado em todos os participantes. Um sistema de tomografia de coerência óptica de domínio espectral (SD-OCT) foi utilizado para medir as espessuras da camada de células ganglionares plexiforme interna (GC-IPL) e da camada de fibras nervosas da retina (RNFL). Para avaliar o desempenho cognitivo de todos os participantes, foi realizado pelo mesmo neurologista um exame neurológico detalhado, incluindo mini-exame do estado mental (MMSE). Resultados: Não houve diferenças significativas entre os grupos em termos de idade (p=0,348) e sexo (p=0,935). Espessuras médias da RNFL foram significativamente diferentes, sendo 85,2 ± 14,7, 76,8 ± 10,3 e 91,4 ± 7,7 µm nos grupos POAG, NTG e controles, respectivamente (p<0,001). As espessuras médias da GC-IPL observadas foram 77.5 ± 9.7 μm no grupo POAG, 73,4 ± 7,8 µm no grupo NTG e 78,8 ± 3,8 µm nos controlos. As diferenças entre os grupos não foram estatisticamente significantes (p=0,085). Graduações do MMSE foram 26,1 ± 1,4, 25,7 ± 2,3 e 28,8 ± 0,9 nos grupos POAG, NTG e controles, respectivamente. Houve diferenças significativas entre os três grupos (p<0,001). Houve diferença significativa entre NTG e saudáveis (p<0,001). Houve diferença significativa entre POAG e saudáveis (p=0,001). Não houve diferença significativa entre o POAG e NTG (p=0,595). Conclusões: Parecem haver fatores de risco semelhantes no glaucoma e nos distúrbios neurodegenerativos que causam deterioração no desempenho cognitivo. Comparando a baixa graduação do MMSE de pacientes com POAG e NTG com controles saudáveis referenda nossa hipótese. Consequentemente recomenda-se que um neurologista também examine os pacientes de glaucoma.

Quality of Life According to Location of Integrated Binocular Visual Field Defect in Normal-Tension-Glaucoma Patients

PURPOSE: To investigate the relationship between vision-related quality of life (QOL) and integrated binocular visual field (IVF) defect and the difference in QOL based on the location of visual field defects in Korean normal tension glaucoma (NTG) patients. METHODS: Two hundred monocular visual fields from 100 patients diagnosed with normal tension glaucoma in at least one eye were integrated using the best location method, and the mean deviation (MD) of whole, superior, and inferior IVF was calculated. We analyzed the correlations between subscales of the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) and each calculated MD using Spearman correlation. After adjusting for confounding factors of age, visual acuity of the better eye, number of medications, and education level, the impact of IVF loss on the composite score of the NEI VFQ-25 was evaluated using multivariate linear regression analysis. RESULTS: The MDs of whole and inferior IVF were significantly associated with 7 of 12 NEI VFQ-25 subscales, and the superior IVF was associated with 3 subscales (p < 0.05). After adjusting confounding variables, the composite score of the NEI VFQ-25 showed significant correlation with whole, superior, and inferior IVF. The adjusted R2 and beta coefficient of the regression line were highest in the whole IVF (Adjusted R2 = 0.451, beta = 1.12), followed by the inferior and superior IVF (Adjusted R2 = 0.438, 0.395, beta = 0.95, 0.85). CONCLUSIONS: The IVF of Korean NTG patients can effectively reflect patient QOL, and the inferior IVF was significantly associated with more subscales of NEI VFQ-25 than was the superior IVF. However, overall QOL of patients is thought to be determined by severity of visual field loss rather than its location.

The Efficacy of Brinzolamide 1%/Brimonidine 0.2% Fixed Combination in Normal Tension Glaucoma

PURPOSE: To evaluate the efficacy and safety of brinzolamide 1%/brimonidine 0.2% fixed combination (BBFC) in normal tension glaucoma (NTG) patients. METHODS: This prospective study included patients treated with brinzolamide 1% monotherapy, brimonidine 0.2% monotherapy or brinzolamide 1% and brimonidine 0.2% concomitant therapy, as well as newly diagnosed NTG patients. The enrolled patients who used brinzolamide 1% or brimonidine 0.2% switched to BBFC and newly diagnosed NTG patients were treated with BBFC. The patients receiving brinzolamide 1% or brimonidine 0.2% monotherapy or brinzolamide 1% and brimonidine 0.2% concomitant therapy switched antiglaucoma drugs to BBFC. Newly diagnosed NTG patients used BBFC as the first therapy. The study consisted of 1 screening/baseline visit and 3 follow-up visits conducted after 1, 4, 8, 12 and 24 weeks of treatment. Intraocular pressure (IOP), mean deviation value and adverse drug reactions were evaluated before treatment and after treatment with BBFC. RESULTS: The mean IOP in the brinzolamide 1% monotherapy group was 13.5 ± 1.6 mm Hg and the mean IOP after switched from brinzolamide 1% monotherapy to BBFC was 12.1 ± 1.5 mm Hg. The mean IOP in the brimonidine 0.2% monotherapy group was 14.2 ± 1.3 mm Hg and the mean IOP after switched from brimonidine 0.2% monotherapy to BBFC was 11.7 ± 1.5 mm Hg. The mean IOP was 11.9 ± 2.1 mm Hg in the brinzolamide 1% and brimonidine 0.2% concomitant therapy group and the mean IOP after switched from brinzolamide 1% and brimonidine 0.2% concomitant therapy to BBFC was 12.0 ± 1.1 mm Hg. The mean IOP and reduction rate were 10.7 ± 2.1 mm Hg and 35.5%, respectively,in the newly diagnosed NTG patients treated with BBFC. There was no serious adverse drug reaction causing ocular damage. CONCLUSIONS: BBFC provides a significant IOP reduction and is a safe antiglaucoma medication for NTG patients.

Correlation between Trans-lamina Cribrosa Pressure Difference and Morphologic Parameters of Optic Disc in Normal Tension Glaucoma Patients

PURPOSE: To investigate the relationship between trans-lamina cribrosa pressure difference (TLCPD) and morphologic parameters of optic disc (OD) in normal tension glaucoma (NTG) patients. METHODS: Data from 31 NTG patients (31 eyes) and 29 controls (29 eyes) were analyzed retrospectively. Their cerebrospinal fluid pressure was estimated using diastolic pressure (DBP), body mass index (BMI) and age. TLCPD was defined as the difference of intraocular pressure (IOP) and the estimated cerebrospinal fluid pressure (ECSFP). Measurements of the rim area (RA), disc area (DA), average and vertical cup/disc (C/D) ratio, retinal nerve fiber layer thickness (RNFLT) and cup volume (CV) were taken for all patients using optical coherence tomography. The correlation between TLCPD and morphologic parameters of OD were assessed. RESULTS: There were no significant differences between the two groups in terms of age, DBP, IOP and spherical equivalent (SE) and BMI. The mean ECSFP was significantly higher in the controls (10.7 ± 2.8 vs. 12.2 ± 2.2 mm Hg, p = 0.031) and TLCPD was significantly higher in patients (2.4 ± 2.1 vs. 4.9 ± 3.7 mm Hg, p = 0.002). In the NTG group, there was a negative correlation between TLCPD and RA (r = -0.595) and positive correlations between TLCPD and the average C/D ratio (r = 0.504), vertical C/D ratio (r = 0.434) and CV (r = 0.420). Average RNLFT was also significantly correlated with TLCPD (r = -0.500) and RNFLT for four quadrants, except the nasal quadrant, in NTG patients. CONCLUSIONS: NTG patients had higher TLCPD. A higher TLCPD was associated with a narrower RA, larger C/D ratio, and thinner RNFLT.

The Short-Term Effect of Prostaglandin Analog Monotherapy on Corneal Biomechanical Properties in Normal Tension Glaucoma Patients

PURPOSE: To evaluate the effects of short-term prostaglandin analogues treatment on the corneal biomechanics of patients with normal tension glaucoma. METHODS: This study included 52 eyes of 52 patients who were diagnosed with normal tension glaucoma. All patients were divided into two groups; one group (27 eyes) received tafluprost while the other group (25 eyes) received travoprost. Intraocular pressure, Biomechanical properties were measured by using goldmann applanation tonometer, ocular response analyzer before treatment and at 8-week after treatment. RESULTS: The mean decrease in intraocular pressure, Goldmann-correlated IOP (IOPg), corneal-compensated intraocular pressure by using Goldmann applanation tonometer, and Ocular response analyzer were statistically significant in total patients, tafluprost, and travoprost group after using prostaglandin analogues (p < 0.001, p < 0.001, p < 0.001, respectively). Corneal hysteresis showed no statistical differences after treatment in total, tafluprost and travoprost group but corneal resistance factor (CRF) showed statistically significant decrease after using prostaglandin analogues in total, tafluprost, and travoprost group (p < 0.001, p = 0.025, p < 0.001). Upon multivariate analysis, the higher initial IOPg and the lower initial CRF checked, the variation of CRF (CRF in baseline – CRF at 8 weeks) got higher (β = 0.134, p = 0.017). CONCLUSIONS: It is needed to carefully monitor and evaluate the effects of prostaglandin analogues on intraocular pressure associated with initial intraocular pressure and the changes of CRF after prostaglandin treatment in normal tension glaucoma patients. CRF is sensitive factor to short-term changes of intraocular pressure after prostaglandin analogues treatment, and it is required to consider the properties of CRF when we evaluate between progression of glaucoma and corneal biomechanical properties.

Comparison of the Progression of High- and Low-tension Glaucoma as Determined by Two Different Criteria

PURPOSE: To investigate and compare the progression of medically treated primary open angle glaucoma according to the baseline intraocular pressure (IOP). METHODS: This study included a total of 345 eyes from 345 patients (mean follow-up period, 4.5 years). Eyes were classified into either conventional normal tension glaucoma (cNTG, 21 mmHg) groups according to the conventional cut-off value of the IOP. Additionally, the median IOP (15 mmHg) was used to create two other groups (median NTG [mNTG] 15 mmHg). Using these values, 306, 39, 153, and 192 eyes were assigned to the cNTG, cHTG, mNTG, and mHTG groups, respectively. Glaucoma progression was determined either by optic disc/retinal nerve fiber layer photographs or serial visual field data. RESULTS: Mean reduction of IOP after medical treatment and of central corneal thickness was lower in the cNTG group, while the prevalence of disc hemorrhage and baseline visual field mean deviation did not differ between the cNTG and cHTG groups. A mean reduction in the IOP was observed after medical treatment, and central corneal thickness was lower in the mNTG group; disc hemorrhage was more frequent in the mNTG than in the mHTG group. Among the 345 analyzed eyes, 100 (29%) showed progression during the follow-up period. In the cHTG group, a higher baseline IOP (hazard ratio, 1.147; p = 0.024) was associated with glaucoma progression. Disc hemorrhage (hazard ratio, 15.533; p < 0.001) was also strongly associated with progression in the mNTG group. CONCLUSIONS: Baseline IOP was a significant risk factor for glaucoma progression in cHTG patients (10% of our total participants), while disc hemorrhage showed the strongest association with progression in the mNTG group, indicating that a cut-off value other than the conventional 21 mmHg is required to define true low-tension glaucoma in populations where NTG predominates among all glaucoma patients.

Measuring Blood Viscosity in Normal Tension Glaucoma Patients

PURPOSE: Non-intraocular pressure (IOP) factors such as vascular factors have been identified as contributing to normal tension glaucoma. However, there is not an established range of haemorheological factors considered normal, nor are there standardized tests. In this study, we investigated differences in blood viscosity and haemorheological parameters between patients with normal tension glaucoma (NTG) and normal controls using a new instrument called the BVD-RO1 (BIO-VISCO. Inc., Jeonju, Korea). METHODS: Twenty patients with NTG and 20 age-matched normal controls were included in the study. Haemorheological parameters of the venous blood samples, including blood viscosity at the shear rates of 300 (high shear rate) and 1 (low shear rate) s-1 were measured using an automated scanning capillary tube viscometer. RESULTS: More hematocrit concentration was detected in the NTG group than in the control group (p < 0.05). Furthermore, higher blood viscosities at the high (p < 0.01) and low (p < 0.01) shear rates were found in the NTG group. CONCLUSIONS: The NTG patients differed in blood viscosity with the control group. This may signify the importance of hemodynamic factors in the pathogenesis of NTG.