The Relationship Between Intraocular Pressure and Visual Field Defect Progression in Normal-tension Glaucoma

Eui Seok Han; Moon Jung Kim; Ki Ho Park

doi:10.3341/jkos.2009.50.10.1548

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

Original Article

J Korean Ophthalmol Soc 2009;50(10):1548-1554.

Published online: 3 August 2009

DOI: https://doi.org/10.3341/jkos.2009.50.10.1548

The Relationship Between Intraocular Pressure and Visual Field Defect Progression in Normal-tension Glaucoma

Eui Seok Han, MD¹, Moon Jung Kim, MD², Ki Ho Park, MD^3,⁴

¹Jeju-si Seobu Public Health Center, Jeju, Korea

²Kangdong Kong Eye Center, Seoul, Korea

³Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

⁴Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea

Address reprint requests to Ki Ho Park, MD Department of Ophthalmology, Seoul National University Hospital #28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-3172, Fax: 82-2-741-3187, E-mail: kihopark@snu.ac.kr

Received 29 April 2009 Accepted 23 June 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Baseline intraocular pressure, Intraocular pressure, Maximal intraocular pressure, Normal-tension glaucoma, Visual field defect progression

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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.

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.

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