Journal List > J Korean Ophthalmol Soc > v.50(10) > 1008396

Han, Kim, and Park: The Relationship Between Intraocular Pressure and Visual Field Defect Progression in Normal-tension Glaucoma

Abstract

Purpose

To investigate the relationship between intraocular pressure (IOP) and visual field defect progression (VFP) in normal- tension glaucoma (NTG).

Methods

We reviewed the records of patients who were enrolled according to the following inclusion criteria: at least one IOP measurement at every section, which was divided into four sections (90 minutes) by IOP measurement time and a follow-up for 2 years or more. Patients were divided into VFP (n=9) and non-visual field defect progression (NVFP, n=28) groups. The baseline IOP was defined as an average IOP measured five times with 90-minute intervals before treatment. The maximal, minimal and mean IOPs were defined as the highest, lowest and average IOPs among all checked IOPs during follow-up. IOP fluctuation was defined as the difference between the maximal and minimal IOPs. The section IOP was defined as an average IOP among all checked IOPs in each section, and section IOP fluctuation was the difference between the highest and lowest section IOPs. We reviewed and compared the IOP indices of the two groups and the risk factors, including hypertension, diabetes, migraine, familial history of glaucoma, disc hemorrhage, and number of eyedrops.

Results

Thirty-seven eyes with an average follow-up of 50.4±18.9 months were included. The baseline and the maximal IOPs were higher than those of the NVFP group (p=0.001 and 0.032, respectively), but the mean, minimal and IOP fluctuations were not different (all, p >0.05). All section IOPs, section IOP fluctuations and other risk factors were not different (all, p >0.05).

Conclusions

The baseline and the highest IOPs were a risk factor of VFP in NTG.

References

1. Choe YJ, Hong YJ. The prevalence of glaucoma in Korean careermen. J Korean Ophthalmol Soc. 1993; 34:153–8.
2. Kwak HW, Joo MJ, Yoo JH. The significance of fundus photography without mydriasis during health mass screening. J Korean Ophthalmol Soc. 1997; 38:1585–9.
3. Cartwright MJ, Anderson DR. Correlation of asymmetric damage with asymmetric intraocular pressure in normal-tension glaucoma. Arch Ophthalmol. 1998; 106:898–900.
4. Araie M, Sekine M, Suzuki Y, Koseki N. Factors contributing to the progression of visual field damage in eyes with normal tension glaucoma. Ophthalmology. 1994; 101:1440–4.
5. Ishida K, Yamamoto T, Sugiyama K, Kitazawa Y. Disk hemorrhage is a significantly negative prognostic factor in normal-tension glaucoma. Am J Ophthalmol. 2000; 129:707–14.
crossref
6. Drance S, Anderson DR, Schulzer M. Risk factors for progression of visual field abnormalities in normal tension glaucoma. Am J Ophthalmol. 2001; 131:699–708.
7. Daugeliene L, Yamamoto T, Kitazawa Y. Risk factors for visual field damage progression in normal-tension glaucoma eyes. Graefes Arch Clin Exp Ophthalmol. 1999; 237:105–8.
crossref
8. Crichton A, Drance SM, Douglas GR, Schulzer M. Unequal intraocular pressure and its relation to asymmetric visual field defects in low-tension glaucoma. Ophthalmology. 1989; 96:1312–4.
crossref
9. Zeimer RC, Wilensky JT, Gieser DK, Viana MA. Association between intraocular pressure peaks and progression of visual field loss. Ophthalmology. 1991; 98:64–9.
crossref
10. Hughes E, Spry P, Diamond J. 24-hour monitoring of intraocular pressure in glaucoma management: a retrospective review. J Glaucoma. 2003; 12:232–6.
crossref
11. Sacca SC, Rolando M, Marletta A, et al. Fluctuations of intraocular pressure during the day in open-angle glaucoma, normal-tension glaucoma and normal subjects. Ophthalmologica. 1998; 212:115–9.
crossref
12. Caprioli J, Coleman AL. Intraocular pressure fluctuation a risk factor for visual field progression at low intraocular pressures in the advanced glaucoma intervention study. Ophthalmology. 2008; 115:1123–9.
13. Bengtsson B, Leske MC, Hyman L, Heijl A. Fluctuation of intraocular pressure and glaucoma progression in the early manifest glaucoma trial. Ophthalmology. 2007; 114:205–9.
crossref
14. Singh K, Shrivastava A. Intraocular pressure fluctuations: how much do they matter? Curr Opin Ophthalmol. 2009; 20:84–7.
crossref
15. Collaborative normal-tension glaucoma study group. Natural history of normal-tension glaucoma. Ophthalmology. 2001; 108:247–53.
16. Kim SH, Park KH. The relationship between recurrent optic disc hemorrhage and glaucoma progression. Ophthalmology. 2006; 113:598–602.
crossref
17. Collaborative normal-tension glaucoma study group. Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Am J Ophthalmol. 1998; 126:487–97.
18. Krieglstein G, Langham ME. Influence of body position on the intraocular pressure of normal and glaucomatous eyes. Ophthalmologica. 1975; 171:132–45.
crossref
19. Jain MR, Marmion VJ. Rapid pneumatic and Mackey-Marg applanation tonometry to evaluate the postural effect on intraocular pressure. Br J Ophthalmol. 1976; 60:687–93.
crossref
20. Tsukahara S, Sasaki T. Postural change of IOP in normalpersons and in patients with primary wide open-angle glaucoma and low-tension glaucoma. Br J Ophthalmol. 1984; 68:389–92.
21. De Vivero C, O'Brien C, Lanigan L, Hitchings R. Diurnal intraocular pressure variation in low-tension glaucoma. Eye. 1994; 8:521–3.
crossref
22. David R, Zangwill L, Briscoe D, et al. Diurnal intraocular pressure variationsan analysis of 690 diurnal curves. Br J Ophthalmol. 1992; 76:280–3.
23. Kano K, Kuwayama Y. Diurnal variation of intraocular pressure in normal-tension glaucoma. Nippon Ganka Gakkai Zasshi. 2003; 107:375–9.
crossref
24. Wilensky JT, Gieser DK, Dietsche ML, et al. Individual variability in the diurnal intraocular pressure curve. Ophthalmology. 1993; 100:940–4.
crossref
25. Asrani S, Zeimer R, Wilensky J, et al. Large diurnal fluctuations in intraocular pressure are an independent risk factor in patients with glaucoma. J Glaucoma. 2000; 9:134–42.
crossref
26. Ishida K, Yamamoto T, Kitazawa Y. Clinical factors associated with progression of normal-tension glaucoma. J Glaucoma. 1998; 7:372–7.
crossref
27. Kim NJ, Lee SM, Park KH, Kim DM. Factors associated with progression of visual field defect in normal tension glaucoma. J Korean Ophthalmol Soc. 2003; 44:1351–5.
28. Jonas JB, Budde W, Stroux A, et al. Single intraocular pressure measurements and diurnal intraocular pressure profiles. Am J Ophthalmol. 2005; 139:1136–7.
crossref
29. Oh JY, Park KH. The effect of latanoprost on intraocular pressure during 12 months of treatment for normal-tension glaucoma. Korean J Ophthalmol. 2005; 19:297–301.
crossref

Figure 1.
The comparison of intraocular pressure indices of 37 eyes with and without visual field defect progression. IOP=intraocular pressure. Mann-Whitney U test. Boxes (25∼75%), bars (the highest and lowest intraocular pressure), and bars in the box (mean intraocular pressure) were displayed.
jkos-50-1548f1.tif
Table 1.
Results of intraocular pressure (IOP, mmHg) indices of 37 eyes
Parameters Mean± standard deviation of IOP (range)
Baseline IOP 14.62±1.98 (10.40∼18.40)
Minimal IOP 10.51±1.69 (7.00∼15.00)
Mean IOP 13.39±1.89 (9.00∼16.83)
Maximal IOP 16.77±2.48 (11.00∼21.50)
IOP fluctuation* 6.21±2.12 (1.33∼13.00)
1st section IOP 13.39±1.89 (9.00∼16.83)
2nd section IOP 13.59±1.73 (10.00∼16.73)
3rd section IOP§ 13.35±2.05 (9.00∼17.75)
4th section IOP 13.62±2.33 (9.50∼18.00)
Section IOP fluctuation# 1.95±0.77 (0.80∼3.67)

* IOP fluctuation=maximal IOP-minimal IOP;

1st section= between 9:00 and 10:29;

2nd section=between 10:30 and 12:00;

§ 3rd section=between 13:00 and 14:29;

4th section= between 14:30 and 16:00;

# Section IOP fluctuation=difference between the highest section IOP and the lowest section IOP.

Table 2.
The comparison of intraocular pressure (IOP, mmHg) indices, which were divided by IOP-measuring time, of 37 eyes with and without visual field defect progression (VFP)
VEP (+) (n=9) Mean± SD (range) VEP (-) (n=28) Mean± SD (range) p value*
1st section IOP 14.24±1.94 12.88±1.90 0.173
(11.2∼16.8) (9.5∼16.4)
2nd section IOP 13.92±1.83 13.43±1.65 0.387
(11.3∼16.3) (10.0∼16.5)
3rd section IOP§ 14.09±1.97 13.18±1.92 0.378
(11.2∼16.7) (9.0∼17.4)
4th section IOP 13.91±2.45 13.30±2.19 0.151
(10.5∼17.8) (9.5∼18.0)
Section IOP fluctuation# 2.13±0.91 1.90±0.74 0.469
(0.9∼3.4) (0.8∼3.7)

* Mann-Whitney U test;

1st section=between 9:00 and 10:29;

2nd section=between 10:30 and 12:00;

§ 3rd section=between 13:00 and 14:29;

4th section=between 14:30 and 16:00;

# Section IOP fluctuation=difference between the highest section IOP and the lowest section IOP.

Table 3.
The clinical data except intraocular pressure of 37 eyes with and without visual field defect progression (VFP)
VFP (+) (n=9) VFP (-) (n=28) p value*
Age (years) 56.4±12.0 49.7±15.3 0.290
Sex (M:F) 2:7 9:19 0.695
Follow-up (months) 58.5±24.9 47.8±16.3 0.186
Hypertension 0 (0%) 9 (32.1%) 0.079
Diabetes 2 (22.2%) 3 (10.7%) 0.577
Migraine 0 (0%) 2 (7.7%) 1.000
Family history of glaucoma 1 (11.1%) 2 (7.1%) 1.000
Disc hemorrhage 3 (33.3%) 7 (25.0%) 0.472
LogMAR V/A 0.037±0.047 0.048±0.088 0.739
Refractive error (SE§, diopters) -1.51±3.52 -1.56±3.26 0.909
Initial MD (dB) -4.27±3.20 -3.91±3.49 0.664
Final MD (dB) -5.05±3.24 -3.28±3.66 0.138
Number of eye drops 1.55±0.46 1.29±0.50 0.180

* Mann-Whitney U test and Fisher’s exact test;

The history of migraine was not evaluated in 2 patients;

LogMAR V/A=Log (minimal angle of resolution) visual acuity;

§ SE=spherical equivalent;

MD=mean deviation.

TOOLS
Similar articles