Comparision of Primary Vascular Dysregulation for Unilateral and Bilateral Eye Involvement in Normal Tension Glaucoma

Dong Wook Choi; Wool Suh; Chang Won Kee

doi:10.3341/jkos.2010.51.5.721

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Choi, Suh, and Kee: Comparision of Primary Vascular Dysregulation for Unilateral and Bilateral Eye Involvement in Normal Tension Glaucoma

Original Article

J Korean Ophthalmol Soc 2010;51(5):721-727.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.5.721

Comparision of Primary Vascular Dysregulation for Unilateral and Bilateral Eye Involvement in Normal Tension Glaucoma

Dong Wook Choi, MD, Wool Suh, MD, Chang Won Kee, MD, PhD

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea

Address reprint requests to Changwon Kee, MD, PhD Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine #50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: 82-2-3410-3564, Fax: 82-2-3410-0074, E-mail: ckee@skku.edu

Received 26 November 2009 Accepted 23 February 2010

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 compare the clinical symptoms and signs of primary vascular dysregulation (PVD) for unilateral and bilateral eye involvement in normal tension glaucoma (NTG).

Methods

The authors administered a questionnaire to assess PVD in patients with NTG. The answers to the 10-item questionnaire (cold hands, migraine, sleep latency, thirst, hypotension, orthostatic hypotension, emotional stress, drug sensitivity, vertigo, and systemic vasospasm) were compared between patients with unilateral involved NTG and bilateral involved NTG (N=61). The groups were classified again according to age (criteria: 55 years), sex, and mean deviation via standard automated perimetry (criteria: −6 dB).

Results

The answers to the questionnaire between patients with unilateral involved NTG and bilateral involved NTG were not different at the level of statistical significance. In groups classified according to age, sex, and mean deviation, none of the answers to the questionnaire were different at the level of statistical significance between the groups.

Conclusions

Clinical symptoms and signs of PVD were not different between patients with unilateral or bilateral eye involvement in NTG. Systemic vascular factors may not be considered different between unilateral and bilateral eye involvement in NTG.

Keywords: Bilateral normal tension glaucoma, Primary vascular dysregulation, Unilateral normal tension glaucoma

References

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Figure 1.

Questionnaire about primary vascular dysregulation

Table 1.

Comparisons between unilateral NTG group and bilateral NTG group

	Unilateral NTG	Bilateral NTG		p-value
	Unilateral NTG	worse eye	better eye	p-value
No. of patients	53		61
Age (years)	± 50.3 12.0	55.	±.9 12.6	0.0179^‡
Gender (M:F)	28: 25	29	9: 32	0.7074^§
IOP (mm Hg)	± 16.9 2.6	± 17.3 2.6	± 17.2 2.7	0.7609^∏
Refraction (diopter)	± −2.84 2.84	± −2.59 2.78	± −2.43 2.55	0.7035^∏
MD^† (decibel)	± −5.51 4.69	± −10.85 7.49	± −5.94 5.33	<0.0001^∏,^#

^* NTG=normal tension glaucoma

^† MD=mean deviation

^‡ Student t-test

^§ Fisher's exact test

^∏ Kruskal-Wallis rank sum test

^# Multiple comparision test: unilateral NTG vs worse eye p=0.0001, unilateral NTG vs better eye p=1.0, worse eye vs better eye p=0.0001.

Table 2.

Comparisons of questionnaire between unilateral NTG group and bilateral NTG group: Number (%)

	Unilateral NTG (53)	Bilateral NTG (61)	p-value
Cold hands	22(41.51)	21(34.43)	0.4364
Migraine	22(41.51)	21(34.43)	0.4364
Sleep latency	22(41.51)	25(40.98)	0.9546
Thirst	28(52.83)	25(40.98)	0.9546
Hypotension	10(18.87)	9(14.75)	0.5566
Orthostatic hypotension	12(22.64)	17(27.87)	0.5227
Emotional stress	34(64.15)	36(59.02)	0.5743
Drug sensitivity	9(16.98)	15(24.59)	0.3203
Vertigo	10(18.87)	10(16.39)	0.7290
Systemic vasospasm	5(9.43)	10(16.39)	0.2729

^* NTG=normal tension glaucoma; P-value=chi square test.

Table 3.

Comparisons of questionnaire between male unilateral NTG group and male bilateral NTG group: Number (%)

	Male unilateral NTG(28)	Male bilateral NTG(29)	p-value
Cold hands	8(28.57)	7(24.14)	1^†
Migraine	6(21.43)	9(31.03)	0.8206^†
Sleep latency	9(32.14)	9(31.03)	1^†
Thirst	10(35.71)	9(31.03)	1^†
Hypotension	3(10.71)	3(10.34)	1^‡
Orthostatic hypotension	5(17.86)	9(31.03)	0.4958^†
Emotional stress	17(60.71)	15(51.72)	0.9882^†
Drug sensitivity	3(10.71)	5(17.24)	1^‡
Vertigo	5(17.86)	4(13.79)	1^‡
Systemic vasospasm	2(7.14)	6(20.69)	1^‡

^* NTG=normal tension glaucoma

^† Chi square test and Bonferroni's correction

^‡ Fisher's exact test and Bonferroni's correction.

Table 4.

Comparisons of questionnaire between female unilateral NTG group and female bilateral NTG group: Number (%)

	Female unilateral NTG(25)	Female bilateral NTG(32)	p-value
Cold hands	14(56.00)	14(43.75)	1^†
Migraine	16(64.00)	12(37.50)	0.0941^†
Sleep latency	13(52.00)	16(50.00)	1^†
Thirst	18(72.00)	16(50.00)	0.18592^†
Hypotension	7(28.00)	6(18.75)	0.8178^†
Orthostatic hypotension	7(28.00)	8(25.00)	1^†
Emotional stress	17(68.00)	21(65.63)	1^†
Drug sensitivity	6(24.00)	10(31.25)	1^†
Vertigo	5(20.00)	6(18.75)	1^‡
Systemic vasospasm	3(12.00)	4(12.50)	1^‡

^* NTG=normal tension glaucoma

^† Chi square test and Bonferroni's correction

^‡ Fisher's exact test and Bonferroni's correction.

Table 5.

Comparisons of questionnaire between young (age<55 years) unilateral NTG group and young age bilateral NTG group: Number (%)

	Young unilateral NTG(30)	Young bilateral NTG(24)	p-value
Cold hands	14(46.67)	9(37.50)	0.9970^†
Migraine	12(40.00)	12(50.00)	0.9248^†
Sleep latency	12(40.00)	9(37.50)	1^†
Thirst	16(53.33)	8(33.33)	0.2832^†
Hypotension	4(13.33)	1(4.17)	0.6346^‡
Orthostatic hypotension	5(16.67)	7(29.17)	0.5446^†
Emotional stress	21(70.00)	19(79.17)	0.890^†
Drug sensitivity	3(10.71)	5(17.24)	0.9786^‡
Vertigo	6(20.00)	5(20.83)	1^‡
Systemic vasospasm	1(3.33)	3(12.50)	0.6246^‡

^* NTG=normal tension glaucoma

^† Chi square test and Bonferroni's correction

^‡ Fisher's exact test and Bonferroni's correction.

Table 6.

Comparisons of questionnaire between old (age 55 years) unilateral NTG and old bilateral NTG: Number (%)≥

	Old unilateral NTG(23)	Old bilateral NTG(37)	p-value
Cold hands	8(34.78)	12(32.43)	1^†
Migraine	10(43.48)	9(24.32)	0.2420^†
Sleep latency	10(43.48)	16(43.24)	1^†
Thirst	12(52.17)	17(45.95)	1^†
Hypotension	6(26.09)	8(21.62)	1^†
Orthostatic hypotension	7(41.18)	10(27.03)	1^†
Emotional stress	13(56.52)	17(45.95)	0.8514^†
Drug sensitivity	5(21.71)	10(27.03)	1^†
Vertigo	4(17.39)	5(13.51)	1^‡
Systemic vasospasm	4(17.39)	7(18.92)	1^‡

^* NTG=normal tension glaucoma

^† Chi square test and Bonferroni's correction

^‡ Fisher's exact test and Bonferroni's correction.

Table 7.

Comparisons of questionnaire between mild (mean deviation > −6) unilateral NTG and mild bilateral NTG: Number (%)

	Mild unilateral NTG(33)	Mild bilateral NTG(19)	p-value
Cold hands	15(54.45)	6(31.58)	0.6522^†
Migraine	14(42.42)	7(36.84)	1^†
Sleep latency	14(42.42)	10(52.63)	0.9542^†
Thirst	16(48.48)	7(36.84)	0.8312^†
Hypotension	6(18.18)	1(5.26)	0.4844^‡
Orthostatic hypotension	7(21.21)	6(31.58)	1^‡
Emotional stress	23(69.70)	13(68.42)	1^†
Drug sensitivity	4(12.12)	6(31.58)	0.2848^‡
Vertigo	4(12.12)	4(21.05)	0.8954^‡
Systemic vasospasm	4(12.12)	2(10.53)	1^‡

^* NTG=normal tension glaucoma

^† Chi square test and Bonferroni's correction

^‡ Fisher's exact test and Bonferroni's correction.

Table 8.

Comparisons of questionnaire between moderate & severe (mean deviation ≤ −6) unilateral NTG and moderate & severe bilateral NTG: Number (%)

	Advanced unilateral NTG(20)	Advanced bilateral NTG(42)	p-value
Cold hands	7(35.00)	15(35.71)	1^†
Migraine	8(40.00)	14(33.33)	1^†
Sleep latency	8(40.00)	15(35.71)	1^†
Thirst	12(60.00)	17(42.86)	0.4134^†
Hypotension	4(20.00)	8(19.05)	1^‡
Orthostatic hypotension	5(25.00)	11(26.19)	1^‡
Emotional stress	11(55.00)	23(54.76)	1^†
Drug sensitivity	5(25.00)	9(21.43)	1^‡
Vertigo	6(30.00)	6(14.29)	0.3538^‡
Systemic vasospasm	1(5.00)	8(19.05)	0.4988

^* NTG=normal tension glaucoma

^† Chi square test and Bonferroni's correction

^‡ Fisher's exact test and Bonferroni's correction.

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