Bianca N Susanna1, Nara G Ogata2, Alessandro A Jammal2, Carolina N Susanna1, Samuel I Berchuck3, Felipe A Medeiros4. 1. Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; ABC Foundation School of Medicine, Santo André, Brazil; Hamilton Glaucoma Center, University of California, San Diego, La Jolla, California. 2. Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina. 3. Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Statistical Science and Forge, Duke University, Durham, North Carolina. 4. Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina. Electronic address: felipe.medeiros@duke.edu.
Abstract
PURPOSE: To investigate the incidence and risk factors for glaucomatous visual field progression in eyes with well-controlled intraocular pressure (IOP). DESIGN: Prospective cohort. PARTICIPANTS: A total of 460 eyes of 334 patients with glaucoma under treatment. METHODS: Study subjects had a mean follow-up of 4.3±0.8 years. Patients were classified as well controlled if all IOP measurements were less than 18 mmHg. Rates of visual field progression were calculated using ordinary least-squares linear regression of standard automated perimetry (SAP) mean deviation (MD) values over time. Progression was defined as a significantly negative MD slope (alpha = 0.05). MAIN OUTCOME MEASURES: Rates of SAP MD change; mean and peak IOP, and IOP fluctuation; and corneal biomechanics: corneal hysteresis (CH), central corneal thickness (CCT), and corneal index. RESULTS: Of the 179 eyes with well-controlled IOP, 42 (23.5%) demonstrated visual field progression. There was no significant difference between progressing and stable patients in baseline MD (-6.4±7.1 decibels [dB] vs. -6.0±6.2 dB; P = 0.346), mean IOP (11.7±2.0 mmHg vs. 12.1±2.3 mmHg; P = 0.405), IOP fluctuation (1.6±0.6 mmHg vs. 1.6±0.5 mmHg; P = 0.402), or peak IOP (14.3±1.9 mmHg vs. 14.6±2.1 mmHg; P = 0.926). Progressing eyes had significantly lower CH (8.6±1.3 mmHg vs. 9.4±1.6 mmHg; P = 0.014) and thinner CCT (515.1±33.1 μm vs. 531.1±42.4 μm; P = 0.018, respectively) compared with stable eyes. In the multivariate analysis, a 1 standard deviation lower corneal index, a summation of normalized versions of CH and CCT, resulted in a 68% higher risk of progression (odds ratio, 1.68; 95% confidence interval, 1.08-2.62; P = 0.021). CONCLUSIONS: Approximately one-quarter of eyes with well-controlled IOP may show visual field progression over time. Thin cornea and low CH are main risk factors.
PURPOSE: To investigate the incidence and risk factors for glaucomatous visual field progression in eyes with well-controlled intraocular pressure (IOP). DESIGN: Prospective cohort. PARTICIPANTS: A total of 460 eyes of 334 patients with glaucoma under treatment. METHODS: Study subjects had a mean follow-up of 4.3±0.8 years. Patients were classified as well controlled if all IOP measurements were less than 18 mmHg. Rates of visual field progression were calculated using ordinary least-squares linear regression of standard automated perimetry (SAP) mean deviation (MD) values over time. Progression was defined as a significantly negative MD slope (alpha = 0.05). MAIN OUTCOME MEASURES: Rates of SAP MD change; mean and peak IOP, and IOP fluctuation; and corneal biomechanics: corneal hysteresis (CH), central corneal thickness (CCT), and corneal index. RESULTS: Of the 179 eyes with well-controlled IOP, 42 (23.5%) demonstrated visual field progression. There was no significant difference between progressing and stable patients in baseline MD (-6.4±7.1 decibels [dB] vs. -6.0±6.2 dB; P = 0.346), mean IOP (11.7±2.0 mmHg vs. 12.1±2.3 mmHg; P = 0.405), IOP fluctuation (1.6±0.6 mmHg vs. 1.6±0.5 mmHg; P = 0.402), or peak IOP (14.3±1.9 mmHg vs. 14.6±2.1 mmHg; P = 0.926). Progressing eyes had significantly lower CH (8.6±1.3 mmHg vs. 9.4±1.6 mmHg; P = 0.014) and thinner CCT (515.1±33.1 μm vs. 531.1±42.4 μm; P = 0.018, respectively) compared with stable eyes. In the multivariate analysis, a 1 standard deviation lower corneal index, a summation of normalized versions of CH and CCT, resulted in a 68% higher risk of progression (odds ratio, 1.68; 95% confidence interval, 1.08-2.62; P = 0.021). CONCLUSIONS: Approximately one-quarter of eyes with well-controlled IOP may show visual field progression over time. Thin cornea and low CH are main risk factors.
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