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

PLoS ONE ◽  
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.

scholarly journals Retrobulbar Hemodynamics and Visual Field Progression in Normal Tension Glaucoma: A Long-Term Follow-Up Study

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
D. Kuerten ◽  
M. Fuest ◽  
E. C. Koch ◽  
A. Koutsonas ◽  
N. Plange
Keyword(s):  
Visual Field ◽  
Normal Tension Glaucoma ◽  
Doppler Imaging ◽  
Progression Rate ◽  
Visual Field Progression ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
Retrobulbar Hemodynamics

Purpose. Vascular risk factors are important factors in the pathogenesis of glaucoma. The purpose of this research was to investigate retrobulbar hemodynamics and visual field progression in patients with normal tension glaucoma (NTG).Patients and Methods. 31 eyes of 16 patients with NTG were included in a retrospective long-term follow-up study. Colour Doppler imaging was performed at baseline to determine various CDI parameters in the different retrobulbar vessels. The rate of visual field progression was determined using the Visual Field Index (VFI) progression rate per year (in %). To be included in the analysis, patients had at least 4 visual field examinations with a follow-up of at least 2 years.Results. Mean follow-up was 7.6 ± 4.1 years with an average of 10 ± 5 visual field tests. The mean MD (mean defect) at baseline was −7.61 ± 7.49 dB. The overall VFI progression was −1.14 ± 1.40% per year. A statistical significant correlation between VFI progression and the RI of the NPCA and PSV of the CRA was found.Conclusion. Long-term visual field progression may be linked to impaired retrobulbar hemodynamics in patients with NTG only to a limited degree. Interpretation of the data for an individual patient seems to be limited due to the variability of parameters.

scholarly journals Impact of intraocular pressure fluctuations on progression of normal tension glaucoma

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.

Abstract P336: Blood Pressure Responses to Cold Pressor Test and Incidence of Hypertension: The GenSalt Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Jiang He ◽  
Qi Zhao ◽  
Lydia A Bazzano ◽  
Jing Chen ◽  
Jichun Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Sympathetic Nervous System Activity ◽  
Left Hand ◽  
Nervous System Activity ◽  
Sympathetic Nervous ◽  
Ice Water

The cold pressor test (CPT), which measures the response of blood pressure (BP) to the stimulus of external cold, has long been a standard test to characterize sympathetic nervous system activity and has been documented to predict cardiovascular risk. We conducted a CPT among 1,998 Han Chinese in 2003-05 and followed the study participants in 2008-09 and 2011-12 for incidence of hypertension. CPT was conducted after the participant had remained sitting for 20 minutes. The participant immersed his or her left hand in the ice water bath (3°C to 5°C) for 1 minute and BP measurements at 0, 60, 120, and 240 seconds were obtained after the left hand had been removed from the ice water bath. During the follow-up examinations, 3 BP measurements were obtained on each of 3 clinical visits. The maximum and area-under-curve (AUC) of systolic BP responses (mean ± SD) to CPT were 13.9±10.2 and 17.1±22.9 at the baseline examination. Over an average of 7.4 years of follow-up, we identified 490 incidence hypertension cases (systolic BP≥140 mmHg and/or diastolic BP ≥90 mmHg and/or use of antihypertensive medication). The age-adjusted cumulative incidences of hypertension by the quartiles of systolic BP responses to CPT were showed in the following table. These associations remained after adjustment for multiple covariates. Our study identified a strong and independent association between BP responses to CPT and subsequent incidence of hypertension. These data suggest that increased sympathetic nervous system activity may play a role in the development of hypertension.

Impact of myopia on the association of long-term intraocular pressure fluctuation with the rate of progression in normal-tension glaucoma

2020 ◽  
pp. bjophthalmol-2019-315441
Author(s):  
Jinho Lee ◽  
Eun Jung Ahn ◽  
Yong Woo Kim ◽  
Ahnul Ha ◽  
Young Kook Kim ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Visual Field ◽  
Normal Tension Glaucoma ◽  
Mean Deviation ◽  
Linear Regression Models ◽  
Risk Effect ◽  
Rate Of Progression ◽  
Topical Medications

Background/AimsTo investigate whether the association of long-term intraocular pressure (IOP) fluctuation with the rate of progression of normal-tension glaucoma (NTG) differs between myopia and non-myopia.MethodsThe medical records of 65 myopic NTG (axial length (AL) > 24.0 mm) and 64 non-myopic NTG eyes (AL < 24.0 mm), who had been treated with topical medications for more than 5 years, were reviewed. Multiple linear regression models were fitted to analyse the relationships of the slope of mean deviation (MD) or visual field index (VFI) with the clinical factors, including the interactions with myopia.ResultsThe average follow-up period was 8.3 years. Twenty-two (22) non-myopic eyes (34.4%) and 27 myopic eyes (41.5%) showed NTG progression (p=0.511). The interaction of myopia with IOP fluctuation was a significant factor regarding both MD and VFI slope (p=0.002, 0.024, respectively); stratified analyses suggested that the risk effect of IOP fluctuation was significant only in myopic NTG in terms of both MD (β= −1.27, p=0.003) and VFI slope (β=−2.32, p=0.011).ConclusionLong-term IOP fluctuation was significantly related to faster visual field progression in myopic NTG eyes, compared with non-myopic NTG eyes.

scholarly journals A longitudinal observation of a patient with normal tension glaucoma

2017 ◽  
Vol 76 (1) ◽  
Author(s):  
Hlupheka L. Sithole
Keyword(s):  
Intraocular Pressure ◽  
Visual Field ◽  
Normal Tension Glaucoma ◽  
Field Analysis ◽  
Visual Field Defects ◽  
Due Diligence ◽  
Longitudinal Observation ◽  
Eye Examination ◽  
Field Defects

Normal tension glaucoma (NTG) is a disease associated with normal intraocular pressure (10 mmHg – 21 mmHg) that may lead to irreversible blindness if misdiagnosed or left untreated over a period of time. The author observed a patient with NTG over a period of 5 years (from 2013 to 2017). The initial visual field analysis results (2014) showed mild visual field defects because of NTG at the start of the 5-year period. Although the patient was also diagnosed with hydrocephalus, a condition associated with optic nerve head damage, following years of noncompliance to treatment of NTG and follow-up eye examination schedules, the patient’s visual field defects were found to have progressed by the year 2017. It is therefore important for optometrists to apply due diligence when examining patients with NTG in order to expedite intervention and prevention of visual impairment and blindness.

scholarly journals Population-based associations between progression of normal-tension glaucoma and Yang-deficient constitution among Chinese persons

2021 ◽  
pp. bjophthalmol-2021-319210
Author(s):  
Lewei Tang ◽  
Liang Chen ◽  
Cong Ye ◽  
Jingwei Zheng ◽  
Yi Zhou ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Chinese Medicine ◽  
Visual Field ◽  
Traditional Chinese Medicine ◽  
Normal Tension Glaucoma ◽  
Population Based ◽  
The Body ◽  
Mean Deviation ◽  
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.

Relationship between mean follow-up intraocular pressure, rates of visual field progression and current target intraocular pressure guidelines

2020 ◽  
pp. bjophthalmol-2020-317406
Author(s):  
Bruna Melchior ◽  
Carlos Gustavo De Moraes ◽  
Jayter S Paula ◽  
George A Cioffi ◽  
Christopher A Girkin ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Visual Field ◽  
Treatment Guidelines ◽  
Evaluation Study ◽  
Mean Deviation ◽  
Racial Groups ◽  
Current Guideline ◽  
Registration Number ◽  
The Mean

AimsTo investigate if eyes presenting intraocular pressure (IOP) within the limits of current guideline-driven target IOP indeed experience slow rates of glaucomatous visual field (VF) progression.MethodsA total of 8598 24-2 VF tests from 603 eyes from the African Descent and Glaucoma Evaluation Study with manifest glaucoma were included. The sample was split into three groups based on baseline VF mean deviation (MD): G1 (better than −5.0 dB), G2 (−5.0 to −10 dB) and G3 (worse than −10 dB). We investigated the relationship between existing target IOP guidelines and rates of MD progression in these groups.ResultsFor stable eyes, the medians and IQR of the mean follow-up IOP were G1=15.0 mmHg (IQR: 13.1 to 17.7), G2=13.2 mmHg (IQR: 11.6 to 14.3) and G3=11.9 mmHg (IQR: 10.1 to 13.8) (p<0.01). When considering the mean follow-up IOP within the limits proposed by current guidelines, the median MD slopes were: −0.20 dB/y (IQR: −0.43 to −0.02) for G1<21 mmHg, −0.19 dB/y (IQR: −0.51 to −0.01) for G2<18 mmHg and −0.15 dB/y (IQR: −0.47 to 0.05) for G3<15 mmHg (p=0.63). There were no significant differences between racial groups.ConclusionIn a sample of patients with manifest glaucoma, despite substantial variability between eyes, adherence to treatment guidelines helped slow the rates of global VF progression at various stages of disease.Trial registration numberclinicaltrials.gov Identifier: NCT00221923.

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

2009 ◽  
Vol 75 (S224) ◽  
pp. 43-44 ◽  
Author(s):  
L. Fontana ◽  
A. C. Viswanathan ◽  
D. Poinooswamy ◽  
R. A. Hitchings ◽  
L. Scullica
Keyword(s):  
Intraocular Pressure ◽  
Visual Field ◽  
Normal Tension Glaucoma ◽  
Visual Field Progression

scholarly journals Arteriovenous Passage Times and Visual Field Progression in Normal Tension Glaucoma

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
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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