Cluster Formation for Analyses of Glaucomatous Visual Field Defects in Central 10-2 Visual Field in Normal Tension Glaucoma Eyes.

Purpose: To develop a cluster system to analyze the retinal sensitivity loss of 68 test points in the central 10 degrees of standard automated perimetry (SAP) in eyes with normal tension glaucoma (NTG). Patients and Methods: Patients with NTG who met the following criteria were included: visual acuity ≥0.7, SAP-derived mean deviation ≥-15 dB, and pattern deviation probability plots with at least one point with a probability of <0.5% and/or two or more contiguous points with a probability of <1% that did not cross the horizontal meridian in the central 12 points of the 24-2 test points. SAP with the Swedish Interactive Threshold Algorithm Standard (SITA-S) 10-2 program (10-2) was performed within 6 months of the SITA-S 24-2. The averaged total deviation (TD) for each of the 68 test points in the 10-2 was calculated. Hierarchical cluster analyses were performed based on the deviation of the TDs of the test points, and a dendrogram was created. The number of clusters was determined following the Sturges' rule. Results: One hundred and twenty-six eyes of 126 patients (61.9±11.4 years) were studied. Hierarchical cluster analysis of the TD values statistically obtained a dendrogram that divided the 68 test points into 7 clusters. Of these 7 clusters, 21 points belonging to the clusters in the papillomacular region included cluster 5. Cluster 5 was distributed above and below the horizontal meridian, which does not agree with the course of the retinal nerve fiber layer (RNFL). Conclusion: The hierarchical cluster analysis of the TD values stratified the 68 test points of the 10-2 into seven clusters. Considering the course of the RNFL, cluster 5 was divided into clusters of 5a and 5b, and consequently eight clusters were considered to be appropriate for detecting glaucomatous visual field defects in the central 10 degrees in NTG eyes.

Evaluation of Pupil Fields Using a Newly Developed Head-mounted Perimeter in Healthy Subjects.

PURPOSE: The purpose of this study was to evaluate the accuracy of pupil fields and determine the normative pupillary response data by age using a newly developed head-mounted perimeter. METHODS: A total of 100 healthy subjects (age, 20 to 68 y) were enrolled. The newly developed head-mounted perimeter "imo" was used to measure the percentage pupil constriction (PPC) as response to a stimulus at all 36 test points of the visual field. Goldmann size III and V stimuli at 0, 8, and 11 decibels (dB) under 31.4, 6, and 3 apostilbs (asb) background were presented. The PPC correlations (r) of the right and left eyes were examined. Reproducibility was determined with the coefficient of variation (CV) and a Bland-Altman plot. By a simple bootstrap method, the mean PPC were analyzed as normative data in all 36 test points. RESULTS: Excellent correlation between both eyes was obtained for Goldmann size V stimuli, target luminance of 0 dB, and a background luminance of 31.4 asb (r=0.83; P<0.001). From the test-retest CV peripheral areas have low reproducibility compared with central areas. With a Goldmann size V target, there was a steeper decline of the PPC from the center field to the periphery field, and the temporal field PPC was larger than the nasal field. No major differences were observed between the PPC data and the age groups by decade (eg, center 3 degrees; P=0.223-0.913). CONCLUSIONS: Normative PPC data might well be useful for assessing objective visual fields with the newly developed head-mounted perimeter.

Relationship between visual field progression and baseline refraction in primary open-angle glaucoma.

PURPOSE: To analyze the relationship between visual field (VF) progression and baseline refraction in Japanese patients with primary open-angle glaucoma (POAG) including normal-tension glaucoma. PATIENTS AND METHODS: In this retrospective study, the subjects were patients with POAG who had undergone VF tests at least ten times with a Humphrey Field Analyzer (Swedish interactive thresholding algorithm standard, Central 30-2 program). VF progression was defined as a significantly negative value of mean deviation (MD) slope at the final VF test. Multivariate logistic regression models were applied to detect an association between MD slope deterioration and baseline refraction. RESULTS: A total of 156 eyes of 156 patients were included in this analysis. Significant deterioration of MD slope was observed in 70 eyes of 70 patients (44.9%), whereas no significant deterioration was evident in 86 eyes of 86 patients (55.1%). The eyes with VF progression had significantly higher baseline refraction compared to those without apparent VF progression (-1.9±3.8 diopter [D] vs -3.5±3.4 D, P=0.0048) (mean ± standard deviation). When subject eyes were classified into four groups by the level of baseline refraction applying spherical equivalent (SE): no myopia (SE > -1D), mild myopia (-1D ≥ SE > -3D), moderate myopia (-3D ≥ SE > -6D), and severe myopia (-6D ≥ SE), the Cochran-Armitage trend analysis showed a decreasing trend in the proportion of MD slope deterioration with increasing severity of myopia (P=0.0002). The multivariate analysis revealed that baseline refraction (P=0.0108, odds ratio [OR]: 1.13, 95% confidence interval [CI]: 1.03-1.25) and intraocular pressure reduction rate (P=0.0150, OR: 0.97, 95% CI: 0.94-0.99) had a significant association with MD slope deterioration. CONCLUSION: In the current analysis of Japanese patients with POAG, baseline refraction was a factor significantly associated with MD slope deterioration as well as intraocular pressure reduction rate. When baseline refraction was classified into four groups, MD slope in myopia groups was less deteriorated as compared to those in the emmetropic/hyperopic group.

Relationship between consecutive deterioration of mean deviation value and progression of visual field defect in open-angle glaucoma.

PURPOSE: To analyze the relationship between consecutive deterioration of mean deviation (MD) value and glaucomatous visual field (VF) progression in open-angle glaucoma (OAG), including primary OAG and normal tension glaucoma. PATIENTS AND METHODS: The subjects of the study were patients undergoing treatment for OAG who had performed VF tests at least 10 times with a Humphrey field analyzer (SITA standard, C30-2 program). The VF progression was defined by a significantly negative MD slope (MD slope worsening) at the final VF test during the follow-up period. The relationship between the MD slope worsening and the consecutive deterioration of MD value were retrospectively analyzed. RESULTS: A total of 165 eyes of 165 patients were included in the analysis. Significant progression of VF defects was observed in 72 eyes of 72 patients (43.6%), while no significant progression was evident in 93 eyes of 93 patients (56.4%). There was significant relationship between the frequency of consecutive deterioration of MD value and MD slope worsening (P<0.0001, Cochran-Armitage trend test). A significant association was observed for MD slope worsening in the eyes with three (odds ratio: 2.1, P=0.0224) and four (odds ratio: 3.6, P=0.0008) consecutive deterioration of MD value in multiple logistic regression analysis, but no significant association in the eyes with two consecutive deterioration (odds ratio: 1.1, P=0.8282). The eyes with VF progression had significantly lower intraocular pressure reduction rate (P<0.01). CONCLUSION: This retrospective study has shown that three or more consecutive deterioration of MD value might be a predictor to future significant MD slope worsening in OAG.

Relationship between progression of visual field defect and intraocular pressure in primary open-angle glaucoma.

PURPOSE: To analyze the relationship between intraocular pressure (IOP) and the progression of visual field defects in Japanese primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG) patients. PATIENTS AND METHODS: The subjects of the study were patients undergoing treatment for POAG or NTG who had performed visual field tests at least ten times with a Humphrey field analyzer (Swedish interactive thresholding algorithm standard, C30-2 program). The progression of visual field defects was defined by a significantly negative value of the mean deviation slope at the final visual field test during the follow-up period. The relationships between the progression of visual field defects and IOP, as well as other clinical factors, were retrospectively analyzed. RESULTS: A total of 156 eyes of 156 patients were included in the analysis. Significant progression of visual field defects was observed in 70 eyes of 70 patients (44.9%), while no significant progression was evident in 86 eyes of 86 patients (55.1%). The eyes with visual field defect progression had significantly lower baseline IOP (P<0.05), as well as significantly lower IOP reduction rate (P<0.01). The standard deviation of IOP values during follow-up was significantly greater in the eyes with visual field defect progression than in eyes without (P<0.05). CONCLUSION: Reducing IOP is thought to be useful for Japanese POAG or NTG patients to suppress the progression of visual field defects. In NTG, IOP management should take into account not only achieving the target IOP, but also minimizing the fluctuation of IOP during follow-up period.

The efficacy and safety of add-on 0.1% brimonidine tartrate preserved with sodium chlorite in on-treatment Japanese normal-tension glaucoma patients.

BACKGROUND: To evaluate the efficacy and safety of newly formulated brimonidine (0.1% brimonidine tartrate preserved with sodium chlorite: brimonidine) as add-on therapy in on-treatment Japanese normal-tension glaucoma (NTG) patients. METHODS: Brimonidine was added to on-treatment NTG patients with intraocular pressures (IOP) of between 13 mmHg and 16 mmHg after three consecutive IOP measurements. The time courses of IOP, conjunctival hyperemia, superficial punctate keratitis, and adverse events were examined at 4, 8, and 12 weeks after brimonidine instillation. RESULTS: Though 75 of 83 patients (31 males and 52 females; mean age: 63.4±11.6 years) completed the study, six patients discontinued because of side effects and two patients withdrew. The mean IOP after brimonidine addition at week 4 (12.6±1.8 mmHg, P<0.001), week 8 (12.4±1.7 mmHg, P<0.001), and week 12 (12.6±1.8 mmHg, P<0.001) was significantly decreased compared with that before the addition of brimonidine (13.9±1.2 mmHg). No significant changes in superficial punctate keratitis or conjunctival hyperemia scores were observed throughout the study. Dizziness, sleepiness, eye pain, and itching (mild to moderate) were noted in five, four, three, and three patients, respectively. CONCLUSIONS: The addition of newly formulated brimonidine to on-treatment Japanese NTG patients with IOP of 13-16 mmHg further reduced the levels of IOP with minimal side effects and adverse events.

Efficacy and safety of tafluprost in normal-tension glaucoma with intraocular pressure of 16 mmHg or less.

PURPOSE: To evaluate the intraocular pressure (IOP)-reducing effects and safety of 0.0015% tafluprost ophthalmic solution (tafluprost) in normal-tension glaucoma (NTG) patients with an IOP of 16 mmHg or less. METHODS: NTG patients with a baseline IOP of 16 mmHg or less were enrolled for a one-eye study in which tafluprost was applied once daily for 12 weeks. The presence of adverse drug reactions and the cumulative incidence of adverse events were also investigated. RESULTS: Among the 44 enrolled patients, 41/44 (93.2%) eyes completed the study. The baseline IOP was 13.2 ± 1.3 mmHg in the study eyes and 13.0 ± 1.3 mmHg in the fellow eyes, which was not statistically significant (P = 0.9173, Student's t test). The values obtained for IOP in the study eyes versus fellow eyes were 10.2 ± 1.6 versus 12.1 ± 1.5 mmHg at week 12. The IOP difference between the study eyes and the fellow eyes was statistically significant (P < 0.0001, Student's t test). The cumulative incidence of adverse events was 58.5% by week 12. Ocular itching was the most frequently observed adverse event (29.3%). All adverse events were clinically tolerable. CONCLUSIONS: Tafluprost induced significant IOP reductions in NTG patients with a baseline IOP of 16 mmHg or less without raising any safety concerns.

Effects of switching to SofZia-preserved travoprost in patients who presented with superficial punctate keratopathy while under treatment with latanoprost.

PURPOSE: To investigate the effects of switching to SofZia-preserved travoprost (TRV) on superficial punctate keratopathy (SPK) observed in patients using benzalkonium chloride (BAC)-preserved latanoprost (LAT). METHODS: Patients with either primary open-angle glaucoma or ocular hypertension treated with LAT for at least 1 month who presented with SPK participated in this prospective, multicenter, open-label uncontrolled study. After the switch from LAT to TRV, patients were monitored at 2 weeks and at 1, 2, and 3 months. The use of concomitantly employed ophthalmic solutions was continued during the observation period. The intensity of SPK in each of five areas defined on the cornea was scored on a standard scale. Repeated measurements were tested with a linear mixed model. RESULTS: Of the 48 patients enrolled, 45 patients completed the study. After the switch to TRV, the mean SPK score in the whole cornea decreased significantly at every observation point (P < 0.0001 at each point) while intraocular pressure did not change significantly. Throughout the observation period, the SPK score tended to be higher in patients using a larger number of concomitant medications that contained BAC. CONCLUSION: Switching to TRV improved SPK observed in a population using LAT, likely because of a decrease in exposure to BAC.

[Comparison of the effects of latanoprost and timolol gel-forming solution on diurnal variation of intraocular pressure in normal-tension glaucoma].

OBJECTIVE: To compare the effects of latanoprost (Lat) and timolol gel-forming solution (Tg) on the diurnal variation of intraocular pressure (IOP) in normal-tension glaucoma (NTG). SUBJECTS AND METHODS: A total of 47 NTG patients (47 eyes) were randomly assigned to receive Lat alone (25 eyes) or Tg alone (22 eyes). IOP was measured at fixed time points during 24 hours before and after treatment with each drug. In addition, blood pressure and pulse rate were measured before and after treatment. RESULTS: Lat reduced IOP significantly at all time points of measurement. Tg reduced IOP significantly at all time points of measurement except at 22:00 and 03:00. Percent reductions in the IOP at 03:00 and in the mean diurnal IOP were significantly greater in the Lat group than in the Tg group. In the Lat group there was no change in diastolic pressure or pulse rate after treatment, but in the Tg group these parameters decreased significantly. CONCLUSIONS: Comparison of diurnal variation of IOP before and after treatment shows that Lat is more effective than Tg in lowering IOP. In addition, Lat does not affect blood pressure or pulse rate.

[Effect of latanoprost on diurnal variations of intraocular pressure in normal-tension glaucoma].

OBJECTIVES: To study the effect of instillation of latanoprost on the diurnal variation in the intraocular pressure(IOP), blood pressure, and pulse rate in patients with normal-tension glaucoma(NTG). SUBJECTS AND METHODS: The diurnal variation in the IOP was determined in 23 eyes in 23 NTG patients after a washout period of 4 weeks or longer. The diurnal variation in IOP was then remeasured after latanoprost monotherapy of 8 weeks or longer. The IOP was measured by the Goldmann applanation tonometer at 10:00, 13:00, 16:00, 19:00, 22:00, 01:00, 03:00, 07:00, and 10:00 before and after treatment, and the IOP at each time point, mean diurnal IOP, maximum IOP, minimum IOP, and range of variation in IOP were compared before and after treatment. The blood pressure and pulse rate before and after treatment were also measured and compared. RESULTS: The IOP decreased significantly at all time points. The treatment caused significant decreases in the mean diurnal IOP, maximum IOP, minimum IOP, and range of variation in IOP. There were no differences in the blood pressure and pulse rate before and after treatment. CONCLUSIONS: Latanoprost significantly decreases the IOP throughout the day in NTG patients, and has no effects on the blood pressure and pulse rate. It is therefore useful in the treatment of NTG.