Surgery for normal tension glaucoma. Target intraocular pressure and visual field progression

PurposeTo explore the association between constitution types as defined by traditional Chinese medicine (TCM) and risk for normal-tension glaucoma (NTG).DesignPopulation-based cohort study.MethodsPersons were identified in a population cohort aged ≥30 years with NTG, defined as having an untreated mean intraocular pressure measurement ≤21 mm Hg over six separate occasions, with no single reading >24 mm Hg (as in the Collaborative Normal Tension Glaucoma Study). The Body Constitution in Traditional Chinese Medicine Questionnaire was used to assess each participant’s TCM constitution types. The association between various constitutions and visual field progression according to Early Manifest Glaucoma Trial criteria was assessed using Cox regression HR models.ResultsAmong 142 participants (245 eyes), 23 persons (17.6%) and 25 eyes (10.2%) progressed, over a mean (SD) follow-up duration of 3.49 (0.99) years. Progression rates were highest in participants with Yang-deficient constitution (n=19, 13.4%), among whom 7 (36.8%) exhibited worsening fields. After adjusting for sex, age, central corneal thickness, retinal nerve fibre layer thickness and mean deviation on visual field testing, Yang-deficient constitution (HR 4.63, 95% CI 1.77 to 12.1, p=0.002) and higher mean intraocular pressure during follow-up (HR 1.25, 95% CI 1.01 to 1.56, p=0.044) were associated with field progression.ConclusionsYang-deficient constitution and higher intraocular pressure are risk factors for visual field progression in NTG patients. Yang deficiency is characterised by abnormal vasoregulation, and these results may be consistent with prior studies linking NTG progression to Raynaud’s phenomenon and migraine.

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Arteriovenous Passage Times and Visual Field Progression in Normal Tension Glaucoma

The Scientific World JOURNAL ◽

10.1155/2013/726912 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Eva Charlotte Koch ◽

Kay Oliver Arend ◽

Marion Bienert ◽

Andreas Remky ◽

Niklas Plange

Keyword(s):

Visual Field ◽

Field Tests ◽

Normal Tension Glaucoma ◽

Retinal Blood Flow ◽

Visual Field Progression ◽

Confocal Scanning Laser Ophthalmoscope ◽

Confocal Scanning ◽

Confocal Scanning Laser ◽

Passage Times

Purpose. Fluorescein angiographic studies revealed prolonged arteriovenous passage (AVP) times and increased fluorescein filling defects in normal tension glaucoma (NTG) compared to healthy controls. The purpose of this study was to correlate baseline AVP and fluorescein filling defects with visual field progression in patients with NTG.Patients and Methods. Patients with a follow-up period of at least 3 years and at least 4 visual field examinations were included in this retrospective study. Fluorescein angiography was performed at baseline using a confocal scanning laser ophthalmoscope (SLO, Rodenstock Instr.); fluorescein filling defects and AVP were measured by digital image analysis and dye dilution curves (25 Hz). Visual field progression was evaluated using regression analysis of the MD (Humphrey-Zeiss, SITA-24-2, MD progression per year (dB/year)). 72 patients with NTG were included, 44 patients in study 1 (fluorescein filling defects) and 28 patients in study 2 (AVP).Results. In study 1 (mean follow-up years, visual field tests), MD progression per year ( dB/year) was significantly correlated to the age (, ) but not to fluorescein filling defects, IOP, or MD at baseline. In study 2 (mean follow-up years, visual field tests), MD progression per year ( dB/year) was significantly correlated to AVP (, ) but not to age, IOP, or MD at baseline.Conclusion. Longer AVP times at baseline are correlated to visual field progression in NTG. Impaired retinal blood flow seems to be an important factor for glaucoma progression.

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Fluctuation of Intraocular Pressure as a Predictor of Visual Field Progression

Archives of Ophthalmology ◽

10.1001/archopht.126.8.1168 ◽

2008 ◽

Vol 126 (8) ◽

pp. 1168 ◽

Cited By ~ 6

Author(s):

Kouros Nouri-Mahdavi

Keyword(s):

Intraocular Pressure ◽

Visual Field ◽

Visual Field Progression

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Intraocular Pressure Reduction in the Treatment of Normal-Tension Glaucoma

50 Studies Every Ophthalmologist Should Know ◽

10.1093/med/9780190050726.003.0012 ◽

2020 ◽

pp. 67-72

Author(s):

Alan D. Penman ◽

Kimberly W. Crowder ◽

William M. Watkins

Keyword(s):

Clinical Trial ◽

Intraocular Pressure ◽

Visual Field ◽

Natural History ◽

Visual Loss ◽

Normal Tension Glaucoma ◽

Pressure Reduction ◽

Glaucomatous Damage ◽

Intraocular Pressure Reduction ◽

History Of

The Collaborative Normal-Tension Glaucoma Study (CNTGS) was a randomized clinical trial to determine the effectiveness of a 30% reduction in intraocular pressure (IOP) (using either medical therapy or filtration surgery) on visual field (VF) progression in eyes with normal-tension glaucoma. The study found that reducing the IOP of patients with normal-tension glaucoma by 30% is beneficial to prevent progression of glaucomatous damage if the visual effects of cataracts are excluded from consideration. However, because not all untreated patients progressed, the natural history of normal-tension glaucoma must be considered before embarking on IOP reduction with therapy that may exacerbate cataract formation, unless normal-tension glaucoma threatens serious visual loss.

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