The Association Between Corneal Biomechanical Properties and Progression of Visual Field Loss in Normal Tension Glaucoma

Jong Hyuk Park; Kyu-Ryong Choi

doi:10.3341/jkos.2013.54.11.1757

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Park and Choi: The Association Between Corneal Biomechanical Properties and Progression of Visual Field Loss in Normal Tension Glaucoma

Original Article

J Korean Ophthalmol Soc 2013;54(11):1757-1766.

Published online: 2 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.11.1757

The Association Between Corneal Biomechanical Properties and Progression of Visual Field Loss in Normal Tension Glaucoma

Jong Hyuk Park, MD, Kyu-Ryong Choi, MD

Department of Ophthalmology, Ewha Womans University School of Medicine, Ewha Institute of Ophthalmology and Optometry, Seoul, Korea

Address reprint requests to Kyu-Ryong Choi, MD, Department of Ophthalmology, Ewha Womans University Mokdong Hôpital, #1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea, Tel: 82-2-2650-5153, Fax: 82-2-2654-4334, E-mail: ckrey02@ewha.ac.kr

Received 8 July 2013 Revised 17 September 2013 Accepted 17 October 2013

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 evaluate the association between corneal biomechanical properties and progression of visual field loss in normal tension glaucoma.

Methods

This study enrolled 73 eyes of 73 patients with normal tension glaucoma who were undergoing medical treatment, and classified them into progressing and nonprogressing groups by visual field trend analysis. The corneal bio- mechanical properties measured by the Ocular Response Analyzer (ORA; Reichert Instruments, Depew, NY, USA), central corneal thickness, and Goldmann applanation tonometry were comparatively analyzed between the 2 groups.

Results

Twenty-six eyes reached a progression endpoint. The prevalence of hypertension was higher in the progressing group (42.3%, progressing, 17.0%, nonprogressing; p = 0.03). Progressing eyes had lower corneal hysteresis (9.1 ± 1.3 vs. 9.8 ± 1.5 mm Hg, p = 0.03) and lower corneal resistance factor (9.5 ± 1.5 vs. 10.4 ± 1.4 mm Hg, p = 0.01) compared with nonprogressing eyes. Upon multivariate analysis, the presence of hypertension (odds ratio [OR] = 3.46, p = 0.03) and corneal hysteresis (CH) (OR = 0.66 per mm Hg lower, p = 0.02) remained statistically significant.

Conclusions

The CH measurement with ORA was significantly associated with risk of visual field progression in normal tension glaucoma. Eyes with lower CH had a greater risk of progression of visual field loss than those with higher CH.

Keywords: Corneal biomechanical properties, Corneal hysteresis, Normal tension glaucoma, Ocular Response Analyzer, Progression

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Figure 1.

Scatterplot matrix illustrating the relationship among corneal hystereris (CH), central corneal thickness (CCT). r = correlation coefficient (statistically significant).

Table 1.

Clinical and ocular characteristics of the progressing and nonprogressing groups

	Progressing^* (n = 26)	Nonprogressing^* (n = 47)	p-value^†
Age (years)	58.0 ± 18.9	55.8 ± 13.1	0.56
Sex, female (%)	14 (53.8)	18 (38.3)	0.23^‡
Diabetes (%)	2 (7.7)	9 (19.1)	0.31^‡
Hypertension (%)	11 (42.3)	8 (17.0)	0.03^‡
Spherical equivalent (diopter)	−1.31 ± 3.11	−1.26 ± 2.42	0.94
Baseline MD (dB)	−3.61 ± 3.09	−3.93 ± 3.35	0.69
Baseline PSD (dB)	4.48 ± 3.09	4.62 ± 3.25	0.86
Baseline IOP (mm Hg)	16.7 ± 3.8	15.8 ± 2.7	0.27
Mean follow-up IOP (mm Hg)	11.6 ± 2.5	12.6 ± 2.7	0.13
IOP reduction (%)	28.9 ± 12.4	20.0 ± 14.1	<0.01
CCT (μm)	528.7 ± 37.6	537.3 ± 31.6	0.33
Number of glaucome medications	1.50 ± 0.71	1.51 ± 0.75	0.95
Follow-up period (months)	67.0 ± 50.2	65.0 ± 51.2	0.87

Values are presented as mean ± SD.

CCT = central corneal thickness; IOP = intraocular pressure; MD = mean deviation; PSD = pattern standard deviation.

^* Glaucomatic progression in Humphrey visual field;

^† Independent t-test;

^‡ Chi-square test.

Table 2.

Corneal biomechanical parameters by ORA of the progressing and nonprogressing groups

	Progressing (n = 26)	Nonprogressing (n = 47)	p-value^*
CRF (mm Hg)	9.1 ± 1.3	9.8 ± 1.5	0.03
CH (mm Hg)	9.5 ± 1.5	10.4 ± 1.4	0.01
IOP GAT (mm Hg)	11.6 ± 2.5	12.6 ± 2.7	0.13
IOP cc (mm Hg)	14.9 ± 4.4	14.3 ± 2.7	0.50
IOP g (mm Hg)	13.4 ± 3.9	13.6 ± 2.6	0.85
IOP GAT-IOP cc (mm Hg)	−3.2 ± 3.4	−1.7 ± 3.2	0.06
IOP GAT-IOP g (mm Hg)	−1.8 ± 2.9	−1.0 ± 2.3	0.23
IOP cc-IOP g (mm Hg)	1.5 ± 1.7	0.7 ± 1.6	0.08

Values are presented as mean ± SD.

ORA = ocular response analyzer; CH = corneal hysteresis; CRF = corneal resistance factor; GAT = Goldmann applanation tonometry; IOP = intraocular pressure; IOP cc = corneal-compensated IOP; IOP g = Goldmann-correlated IOP.

^* Independent t-test.

Table 3.

Number of patients on glaucoma medication treatment by class

	Progressing (n / %)	Nonprogressing (n / %)	Both (n / %)
Prostaglandin analogue	12 / 32.4	20 / 29.0	32 / 30.2
Beta blocker	12 / 32.4	31 / 44.8	43 / 40.5
Carbonic anhydrase inhibitor	7 / 18.9	9 / 13.1	16 / 15.1
Alpha agonist	6 / 18.9	9 / 13.1	15 / 14.2

Table 4.

Statistical correlations between IOP GAT, IOP g, IOP cc, and clinical/ocular characteristics in the progressing and nonprogressing groups

		Progressing	Nonprogressing
IOP GAT	Age	−0.160 (0.43)	−0.261 (0.08)
	SE	−0.128 (0.53)	−0.005 (0.97)
	CCT	0.412 (0.03)	0.210 (0.16)
	CH	−0.131 (0.51)	0.340 (0.02)
	CRF	0.381 (0.04)	0.607 (<0.01)
IOP g	Age	−0.087 (0.67)	−0.130 (0.39)
	SE	−0.265 (0.18)	−0.045 (0.76)
	CCT	0.623 (<0.01)	0.400 (<0.01)
	CH	−0.388 (0.04)	0.030 (0.84)
	CRF	0.487 (0.01)	0.555 (<0.01)
IOP cc	Age	0.033 (0.87)	−0.015 (0.92)
	SE	−0.177 (0.38)	0.124 (0.41)
	CCT	0.523 (<0.01)	0.055 (0.71)
	CH	−0.570 (<0.01)	−0.547 (<0.01)
	CRF	0.168 (0.40)	−0.021 (0.89)

CCT = central corneal thickness; CH = corneal hysteresis; CRF = corneal resistance factor; GAT = Goldmann applanation tonometry; IOP = intraocular pressure; IOP cc = corneal-compensated IOP; IOP g = Goldmann-correlated IOP; SE = spherical equivalent.

Table 5.

Binary logistic regression testing the association between all baseline and intercurrent factors with a progression outcome

	Univariable model		Multivariable model
	OR (95% CI)	p-value	OR (95% CI)	p-value
Age (per decade older)	1.01 (0.98-1.04)	0.56	—	—
Sex (female)	1.88 (0.71-4.96)	0.23	—	—
Presence of diabetes	0.35 (0.07-1.77)	0.31	—	—
Presence of hypertension	3.58 (1.20-10.61)	0.03	3.46 (1.12-10.72)	0.03
Spherical equivalent (diopter)	0.99 (0.83-1.19)	0.94	—	—
Baseline VF MD (dB)	1.03 (0.89-1.20)	0.69	—	—
Baseline VF PSD (dB)	0.99 (0.85-1.15)	0.86	—	—
Baseline IOP	1.09 (0.93-1.27)	0.27	—	—
CCT	0.99 (0.98-1.01)	0.30	—	—
CH (per mm Hg lower)	0.65 (0.46-0.93)	0.02	0.66 (0.46-0.95)	0.02
CRF (per mm Hg lower)	0.67 (0.46-0.99)	0.05	—	—
IOP cc (per mm Hg higher)	1.05 (0.91-1.21)	0.50	—	—
Number of glaucoma medications	0.98 (0.50-1.90)	0.95	—	—

Left = univariate model including each variable independently; Right = stepwise multivariate model including corneal hysteresis and corneal resistance factor along with the other clinical variables; CCT = central corneal thickness; CH = corneal hysteresis; CI = confidence interval; CRF = corneal resistance factor; GAT = Goldmann applanation tonometry; IOP = intraocular pressure; IOP cc = corneal-compensated IOP; MD = mean deviation; PSD = pattern standard deviation; VF = visual field.

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