Intraocular pressure and central visual field of normal tension glaucoma

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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Effects of Oral Brovincamine on Visual Field Damage in Patients with Normal-Tension Glaucoma with Low-Normal Intraocular Pressure

Journal of Glaucoma ◽

10.1097/00061198-199904000-00006 ◽

1999 ◽

Vol 8 (2) ◽

pp. 117???123 ◽

Cited By ~ 37

Author(s):

Nobuyuki Koseki ◽

Makoto Araie ◽

Junkichi Yamagami ◽

Shiroaki Shirato ◽

Sei-ichiro Yamamoto

Keyword(s):

Intraocular Pressure ◽

Visual Field ◽

Normal Tension Glaucoma ◽

Visual Field Damage

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Relationship between peripheral vasospasm and visual field progression rates in patients with normal-tension glaucoma with low-teen intraocular pressure

PLoS ONE ◽

10.1371/journal.pone.0250085 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250085

Author(s):

Do Young Park ◽

Jong Chul Han ◽

Eun Jung Lee ◽

Changwon Kee

Keyword(s):

Regression Analysis ◽

Intraocular Pressure ◽

Visual Field ◽

Cold Pressor Test ◽

Cold Pressor ◽

Normal Tension Glaucoma ◽

Progression Rate ◽

Finger Temperature ◽

Ice Water

Purpose To investigate the association between peripheral vasospasm and the visual field (VF) progression rate in patients with normal-tension glaucoma (NTG) with low-teen intraocular pressure (IOP). Methods The finger temperature of 113 NTG patients was measured before and after exposure to ice water using a Temperature gun (cold pressor test). These patients had confirmed VF progression, despite a low-teen IOP during a follow-up period of >5 years. VF progression rates were calculated as the slope of the visual field index (VFI) and mean deviation (MD) over time. Demographic, systemic, and ocular factors and VF progression rates were compared, based on the cold pressor test results. A regression analysis was used to investigate the factors affecting VF progression rates. Results Mean age, initial IOP, mean IOP during the follow-up period, and initial VF MD were 57.1 years, 15.8 mmHg, 12.0 mmHg, and -5.2 dB, respectively. When patients were divided into two groups (less vasospasm and more vasospasm) according to changes in temperature after exposure to ice water, the VF progression rate was significantly faster in the group with more vasospasm. In a multiple regression analysis, older age, worse initial VF MD, and greater decrease in finger temperature after ice water exposure were significantly associated with faster VF progression rates. Conclusion An excessive drop in finger temperature after exposure to ice water was significantly associated with faster VF progression in patients with low-teen NTG. This suggests that the blood flow in the optic nerve head may also be disturbed by peripheral vasospasm, accelerating glaucomatous damage regardless of IOP.

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Relationship of Progression of Visual Field Damage to Postural Changes in Intraocular Pressure in Patients with Normal-Tension Glaucoma

Ophthalmology ◽

10.1016/j.ophtha.2006.06.014 ◽

2006 ◽

Vol 113 (12) ◽

pp. 2150-2155 ◽

Cited By ~ 63

Author(s):

Takahiro Kiuchi ◽

Yuta Motoyama ◽

Tetsuro Oshika

Keyword(s):

Intraocular Pressure ◽

Visual Field ◽

Normal Tension Glaucoma ◽

Postural Changes ◽

Visual Field Damage ◽

Relationship Of

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Faculty Opinions recommendation of Relationship between peripheral vasospasm and visual field progression rates in patients with normal-tension glaucoma with low-teen intraocular pressure.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.739962033.793585632 ◽

2021 ◽

Author(s):

Julian Garcia-Feijoo ◽

Federico Saenz-Frances

Keyword(s):

Intraocular Pressure ◽

Visual Field ◽

Normal Tension Glaucoma ◽

Visual Field Progression

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Impact of intraocular pressure fluctuations on progression of normal tension glaucoma

International Journal of Ophthalmology ◽

10.18240/ijo.2021.10.12 ◽

2021 ◽

Vol 14 (10) ◽

pp. 1553-1559

Author(s):

Susanne Hopf ◽

◽

Irene Schmidtmann ◽

Norbert Pfeiffer ◽

Esther Maria Hoffmann ◽

...

Keyword(s):

Intraocular Pressure ◽

Visual Field ◽

Optic Disc ◽

Cox Regression ◽

Group Analysis ◽

Normal Tension Glaucoma ◽

Short And Long Term ◽

The Impact

AIM: To investigate short- and long-term intraocular pressure (IOP) fluctuations and further ocular and demographic parameters as predictors for normal tension glaucoma (NTG) progression. METHODS: This retrospective, longitudinal cohort study included 137 eyes of 75 patients with NTG, defined by glaucomatous optic disc or visual field defect with normal IOP (<21 mm Hg), independently from therapy regimen. IOP fluctuation, mean, and maximum were inspected with a mean follow-up of 38mo [standard deviation (SD) 18mo]. Inclusion criteria were the performance of minimum two 48-hour profiles including perimetry, Heidelberg retina tomograph (HRT) imaging, and optic disc photographs. The impact of IOP parameters, myopia, sex, cup-to-disc-ratio, and visual field results on progression of NTG were analyzed using Cox regression models. A sub-group analysis with results from optical coherence tomography (OCT) was performed. RESULTS: IOP fluctuations, average, and maximum were not risk factors for progression in NTG patients, although maximum IOP at the initial IOP profile was higher in eyes with progression than in eyes without progression (P=0.054). The 46/137 (33.5%) eyes progressed over the follow-up period. Overall progression (at least three progression confirmations) occurred in 28/137 eyes (20.4%). Most progressions were detected by perimetry (36/46). Long-term IOP mean over all pressure profiles was 12.8 mm Hg (SD 1.3 mm Hg); IOP fluctuation was 1.4 mm Hg (SD 0.8 mm Hg). The progression-free five-year rate was 58.2% (SD 6.5%). CONCLUSION: Short- and long-term IOP fluctuations do not result in progression of NTG. As functional changes are most likely to happen, NTG should be monitored with visual field testing more often than with other devices.

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