[Effects of optic disc size on progression of visual field defects in normal-tension glaucoma].

PURPOSE: To investigate the influence of optic disc area on the progression of visual field (VF) defects in normal-tension glaucoma (NTG). We evaluated the correlation between the right-left differences of the progression of VF defects and those of the intraocular pressure and the ocular anatomical factors. METHODS: Thirty two eyes of 16 NTG patients with a significant difference between the left and right optic disc area, were followed up for more than 5 years after diurnal variation analyzed with Heidelberg Retina Tomograph (HRT), and without myopic disc shape. The left and right eyes of the patients were allocated to two groups, a group with a relatively smaller eye disc and a group with relatively larger eye disc. They were studied regarding the probability of VF stability using the Kaplan-Meier life-table analysis. In addition, a comparison of clinical factors was evaluated between the two groups (Mann-Whitney U test). RESULTS: The probability of VF stability at the 107-month follow-up was 60 +/- 13% (mean +/- SE)in patients with small disc area, and 25 +/- 11% in patients with large disc area. Optic disc area was found to have significant influence on the progression of VF defects (p = 0.022, log-rank test). In clinical factors, no statistically significant difference except disc area was found between the two groups. CONCLUSIONS: These findings suggest that optic disc area is associated with the progression of VF defects in patients with NTG.

Optic disc size and progression of visual field damage in patients with normal-tension glaucoma.

PURPOSE: Our goal was to evaluate the influence of optic disc size on the progression of visual field damage in patients with normal-tension glaucoma (NTG). SUBJECTS AND METHODS: Eighty-two eyes of 82 NTG patients who had been receiving topical antiglaucoma medications and followed-up for more than 4 years were enrolled in this study. The patients were allocated to two groups, according to the mean size of their optic discs. The data were analyzed using regression analysis, based on the Cox proportional hazard model. RESULTS: The probability of visual field stability was significantly lower in eyes with large discs than in those with small discs (log rank test, P = 0.007). Progression of visual field damage was significantly associated with the optic disc area (hazard ratio [HR]: 1.812, P = 0.018), occurrence of disc hemorrhage (HR: 2.116, P = 0.028), and intraocular pressure reduction ratio (HR: 0.957, P = 0.014). CONCLUSION: The optic disc area correlates with progression of visual field damage in patients with NTG.

Superior segmental optic nerve hypoplasia accompanied by progressive normal-tension glaucoma.

This is the first case report of a superior segmental optic hypoplasia (SSOH) combined with normal-tension glaucoma accompanied by a progressive glaucomatous visual field defect. A 40-year-old man, incidentally diagnosed as having bilateral SSOH, had disc hemorrhage associated with expansion of the width of a retinal nerve fiber layer defect and deterioration of a visual field defect in the right eye during the follow-up period. His left eye showed a stable visual field. The diurnal variation in intraocular pressure (IOP) showed a higher mean IOP in his right eye compared with his left eye, although both IOPs remained under 21 mmHg.

Effect of trabeculectomy on retrobulbar circulation and visual field progression in patients with primary open-angle glaucoma.

BACKGROUND: The purpose of this study was to investigate the relationship between retrobulbar circulation and visual field change in eyes with primary open-angle glaucoma following unilateral trabeculectomy. METHODS: Twenty-one patients with primary open-angle glaucoma were prospectively enrolled. Retrobulbar circulation was evaluated using color Doppler imaging. The peak systolic velocity, end-diastolic velocity, and resistive index were evaluated in the central retinal artery, temporal site of the short posterior ciliary artery (t-SPCA), and nasal site of the short posterior ciliary artery (n-SPCA). Visual field examinations were performed using a Humphrey visual field analyzer before surgery and trimonthly for 12 months postoperatively. RESULTS: In the operative eyes, the end-diastolic velocity was significantly increased in the central retinal artery (P = 0.005, analysis of variance), t-SPCA (P = 0.005), and n-SPCA (P = 0.027). The resistive index was significantly decreased in the central retinal artery (P = 0.003), t-SPCA (P = 0.000), and n-SPCA (P = 0.010) postoperatively compared with preoperatively. The nonoperative contralateral eyes did not show a significant change in end-diastolic velocity or resistive index for either the SPCA or central retinal artery. The mean deviation slope in the operative eyes (-0.26 ± 0.64 dB/year) was significantly slower than that in the nonoperative eyes (-0.65 ± 0.70 dB/year; P = 0.047, Mann-Whitney U test). CONCLUSION: These results suggest that trabeculectomy improves the retrobulbar circulation and prevents the progression of visual field changes in patients with primary open-angle glaucoma.

[Investigation of the correlation between the right-left differences of visual field defects and the right-left differences of ocular anatomical factors in patients with normal-tension glaucoma].

PURPOSE: To investigate the effects of optic disc area to visual field (VF) defects of normal-tension glaucoma (NTG), the correlation between the right-left differences of VF defects and those of diurnal variations of intraocular pressure and the ocular anatomical factors were evaluated in patients with NTG. METHODS: One hundred eighteen eyes of 59 NTG patients with the right-left difference value of mean deviation (MD) of between 2 dB and 12 dB obtained with Humphrey field analyzer program 30-2 were enrolled in the study. The correlation between the right-left differences of MD values and those of refraction, axial length, central cornea thickness, diurnal variation of intraocular pressure, and disc area measured with Heidelberg Retina Tomograph were evaluated by multiple regression analysis. RESULTS: The multiple correlation coefficient was 0.520, and the coefficient of determination was 0.271. The right-left differences of axial length (p = 0.041) and disc area(p = 0.002) were judged to be the statistically significant factors correlated with those of VF defects. CONCLUSIONS: These results suggest that the right-left differences of axial length and disc area are associated with the right-left differences of VF defects in patients with NTG.

[Study on relationship between control of intraocular pressure and systemic risk factor for visual field progression in normal-tension glaucoma].

PURPOSE: To study the relationship between the reduction of intraocular pressure (IOP) and visual field (VF) damage in normal-tension glaucoma (NTG) patients with or without systemic risk factors. METHODS: Ninety-two eyes of 92 patients with NTG were enrolled in this study. All patients were followed up for more than 2 years of taking topical antiglaucoma medications. Personal history regarding migraine, diabetes mellitus, hypertension, cerebrovascular disease, cardiovascular disease, Raynaud's phenomenon, arrhythmia, and family history of glaucoma were collected from the medical records. The survival data were analyzed using regression analysis based on the Cox proportional hazards model. The relationship between the presence of each systemic factor and the effect of reduction of VF progression were evaluated using the life table analysis. RESULTS: The progression of VF damage was significantly associated with IOP (p = 0.020). The eyes with larger IOP reduction showed significantly less VF progression than eyes with smaller IOP reduction both in patients with and without systemic diseases (with systemic diseases p = 0.027, without systemic diseases p = 0.025) and a family history of glaucoma (p = 0.019). In patients with a family history of glaucoma, the rate of VF progression did not show statistically differences between the eyes with larger IOP reduction and those with smaller IOP reduction. CONCLUSIONS: IOP reduction is beneficial in reducing the risk of VF progression regardless of the presence of systemic risk factors in patients with NTG.

Prognostic factors for progression of visual field damage in patients with normal-tension glaucoma.

PURPOSE: To evaluate the rate of progression and the prognostic factors of visual field damage in patients with normal-tension glaucoma (NTG). METHODS: Ninety-two NTG patients (92 eyes) were followed up for more than 2 years with topical antiglaucoma medications. All subjects were classified as having early damaged eyes with an initial mean deviation (MD) of -6 dB or better, moderately damaged eyes with MD between -6 dB and -12 dB, and severely damaged eyes with MD of -12 dB or worse, and survival data were analyzed using regression analysis based on the Cox proportional hazards model. RESULTS: The probability of visual field stability was significantly higher in patients with moderate damage than in those with severe damage (P = 0.035). The patients with early damage showed no difference in the probability of visual field stability compared with patients with moderate or severe damage. The progression of visual field damage was significantly associated with mean intraocular pressure (IOP) (P = 0.000) or IOP fluctuation (P = 0.002) during follow-up regardless of the severity of the initial visual field damage. CONCLUSIONS: The rate of progression of visual field damage differed according to the severity of the initial visual field damage. IOP reductive medication may be effective in preventing glaucomatous visual field progression in patients with NTG.

[Effect of ocular hypotensive medications in preventing the progression of visual field damage in patients with normal-tension glaucoma].

PURPOSE: We investigated the effect of ocular hypotensive medications and the risk factors for progression of visual field damage in patients with normal-tension glaucoma (NTG). SUBJECTS AND METHODS: Sixty-four NTG patients (64 eyes) followed at least 4 years with ocular hypotensive medications were studied regarding the probability of visual field stability using the Kaplan-Meier life-table analysis and multiple regression analysis with the Cox proportional hazards model. RESULTS: Probability of visual field stability was 56% at the 76-month follow-up. Mean intraocular pressure during the follow-up period and generalized cup enlargement type classified according to the optic disc shape were found to have significant influence on the progression of visual field damage. CONCLUSION: These findings suggest that ocular hypotensive medications are effective in stabilizing the visual field. We need to pay attention to the optic disc shape in patients with NTG.

[Postoperative results of non-penetrating trabeculectomy for primary open-angle glaucoma].

PURPOSE: To estimate the postoperative results of non-penetrating trabeculectomy(NPT), the success rate of postoperative intraocular pressure(IOP) and the clinical factors affecting postoperative IOP were evaluated. SUBJECTS AND METHODS: 32 eyes of 32 primary open-angle glaucoma(POAG) patients who underwent NPT as the first filtering surgery were enrolled in the study. We evaluated postoperative IOP using the Kaplan-Meier method, a proportional hazard model, and multiple logistic analysis. RESULTS: 53.2% of all patients had an IOP of less than 16 mmHg without antiglaucoma medication, and 63.8% had an IOP of less than 16 mmHg with antiglaucoma medication 36 months postoperatively. The performance of Nd:YAG trabeculopuncture(YLT) was indicated as a significant factor affecting postoperative IOP by the proportional hazard model(p = 0.037). 72.2% of patients who did not undergo YLT had an IOP of less than 16 mmHg without antiglaucoma medication, and 36.5% who underwent YLT had a postoperative IOP of less than 16 mmHg. There was significant difference between the both groups(log rank test, p = 0.045). Preoperative IOP with antiglaucoma medication was indicated as a significant factor affecting performance of YLT by multiple logistic analysis. CONCLUSION: These results suggest that NPT may be useful to reduce the use of antiglaucoma medication in patients with POAG whose preoperative IOP is controllable with antiglaucoma medication.

Correlation of blue chromatic macular sensitivity with optic disc change in early glaucoma patients.

PURPOSE: To investigate the relationship between morphological changes of the optic nerve head (ONH) and macular sensitivity determined with blue on yellow (B on Y) and white on white (W on W) perimetry in normal subjects and patients with glaucoma. METHODS: One randomly chosen eye was evaluated in each of 28 healthy subjects, 23 patients with ocular hypertension (OH), and 23 patients with early primary open-angle glaucoma (POAG). The mean macular sensitivity determined with B on Y and W on W perimetry was obtained by a macular program using a modified Humphrey field analyzer. The Heidelberg retina tomograph with software version 2.01 was used to evaluate the temporal topographic measurements of ONH. RESULTS: There was no significant difference in temporal ONH parameters among the three clinical groups. The mean macular sensitivity of B on Y and W on W perimetry in early POAG patients was significantly lower than that in healthy subjects and in patients with OH. The mean macular sensitivity of W on W perimetry showed no significant correlation with temporal ONH parameters in any clinical groups. In patients with early POAG, the mean macular sensitivity of B on Y perimetry was significantly related to cup area and volume, cup/disc area ratio, and rim volume in the temporal sector of the ONH. CONCLUSION: The measurement of the mean macular sensitivity of B on Y perimetry might make it possible to detect functional damage prior to morphological changes in the ONH due to elevated intraocular pressure in glaucoma.