Abstract
Purpose
To investigate the influence of water-shed zone (WSZ) and nocturnal dip (ND) on the progression of the glaucomatous visual field (V/F) defects in open-angle glaucoma (OAG) patients when the intraocular pressure (IOP) was maintained under the target pressure.
Methods
We performed fluorescence angiography (FAG), 24-hour ambulatory blood pressure monitoring (24-hr ABPM), and V/F tests. We examined the relationships among WSZ in early-FAG, ND over 10% (dip), and the progression of the glaucomatous V/F defects using chi-square, Fisher's exact, and multivariate logistic regression tests. A p-value < 0.05 was considered statistically significant.
Results
When considering the correlation between WSZ and dip, statistical significance was found in OAG (p = 0.024, odds ratio (OR) = 3.308) and normal tension glaucoma (NTG) (p = 0.029, OR = 4.364) patients. In patients with dip, glaucomatous V/F defects significantly progressed (OAG: p = 0.003, OR = 5.938, NTG: p = 0.005, OR = 13.929). In patients with WSZ, the glaucomatous V/F defects progressed in all groups (OAG: p = 0.002, OR = 5.156, NTG: p = 0.024, OR = 4.750, primary open angle glaucoma (POAG): p = 0.021, OR = 8.750). In the patients with WSZ involving optic nerve head, the glaucomatous V/F defects had progressed in OAG (p = 0.004, OR = 5.958) and NTG (p = 0.009, OR = 8.333) groups. Based on binary logistic regression analysis, dip (p = 0.010, OR = 6.227) significantly affected V/F progression only in OAG patients.
Conclusions
In the OAG and NTG groups, ND over 10% influenced the progression of the glaucomatous V/F defects. The patients with WSZ tended to have ND over 10% in OAG and NTG groups and glaucomatous V/F defects progressed in all patients. Therefore, performing early FAG and 24-hr ambulatory blood pressure monitoring may be helpful for glaucoma patients with progressing glaucomatous V/F defects even when the IOP was maintained under the target pressure.
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Figure 1.
The pattern of watershed zone in fluorescence angiography. (A) 65-year-old female NTG patient shows that watershed zone is not including the optic nerve head. (B) 72-year-old female POAG patient shows that watershed zone including the optic nerve head. NTG = normal tension glaucoma; POAG = primary open-angle glaucoma.
![jkos-55-1030f1.tif](/upload/SynapseXML/0035jkos/thumb/jkos-55-1030f1.gif)
Table 1.
Clinical and demographic data of the patients with OAG
OAG | NTG | POAG | p-value | |
---|---|---|---|---|
M:F (eye) | 22:46 | 11:32 | 11:14 | 0.194* |
Mean age (years) | 62.07 ± 11.32 | 58.35 ± 12.44 | 69.48 ± 9.72 | 0.351† |
Mean baseline IOP (mm Hg) | 19.64 ± 3.68 | 17.57 ± 3.14 | 23.78 ± 4.56 | 0.062† |
Mean IOP (mm Hg) | 13.04 ± 2.64 | 12.89 ± 2.18 | 14.64 ± 3.73 | 0.072† |
Mean Δ IOP decrease (mm Hg) | 6.64 ± 2.98 | 4.68 ± 1.59 | 9.14 ± 3.74 | 0.068† |
Mean Δ IOP decrease (%) | 33.60 ± 3.46 | 26.64 ± 2.57 | 42.65 ± 3.41 | 0.057† |
Mean deviation of visual field (dB) | -5.85 ± 4.84 | -5.59 ± 4.21 | -6.82 ± 6.33 | 0.083† |
Pattern standard deviation of visual field (dB) | -3.89 ± 3.05 | -3.73 ± 3.25 | -4.29 ± 2.96 | 0.682† |
Mean deviation change of visual field (dB) | -3.24 ± 2.86 | -3.26 ± 0.45 | -3.42 ± 2.64 | 0.068† |
Mean AGIS score change (point) | -3.25 ± 2.13 | -3.15 ± 3.16 | -3.49 ± 1.56 | 0.105† |
Mean nocturnal dip of SBP (%) | 7.31 ± 9.16 | 7.26 ± 9.81 | 7.44 ± 8.8 | 0.947† |
Mean nocturnal dip of DBP (%) | 8.84 ± 8.72 | 9.20 ± 8.67 | 8.63 ± 8.94 | 0.817† |
Incidence of watershed zone (%) | 39.71 (27 eyes) | 46.51 (20 eyes) | 28.00 (7 eyes) | 0.135* |
Incidence of watershed zone with ONH involvement (%) | 25.00 (17 eyes) | 27.90 (12 eyes) | 20.00 (5 eyes) | 0.179* |
Table 2.
Anti-glaucoma eyedrops to obtain target intraocular pressure
Groups | Anti-glaucoma eyedrops | Eyes |
---|---|---|
NTG | PG | 21 |
PG + CAI + β-blocker | 12 | |
PG + CAI + β-blocker + α-agonist | 10 | |
POAG | CAI + β-blocker + α-agonist | 12 |
PG + CAI + β-blocker + α-agonist | 13 |
Table 3.
The relationship between watershed zone and nocturnal dip in OAG
p-value* | Odds ratio | ||
---|---|---|---|
OAG | Watershed zone | 0.024 | 3.308 |
ONH involvement with watershed zone | 0.633 | 1.600 | |
NTG | Watershed zone | 0.029 | 4.364 |
ONH involvement with watershed zone | 1.000 | 1.444 | |
POAG | Watershed zone | 0.568 | 1.667 |
ONH involvement with watershed zone | 1.000 | 1.500 |
Table 4.
The risk factors of glaucomatous visual field progression in OAG
Fisher's exact test* |
Binary logistic regression test† |
||||
---|---|---|---|---|---|
p-value | Odds ratio | p-value | Odds ratio | ||
OAG | Sex | 0.931 | 0.1058 | 0.982 | 0.985 |
Age over 60-year-old | 0.189 | 0.966 | 0.060 | 3.672 | |
Nocturnal dip over 10% | 0.003 | 5.938 | 0.010 | 6.227 | |
Watershed zone | 0.002 | 5.156 | 0.210 | 2.841 | |
Watershed zone with ONH involvement | 0.004 | 5.958 | 0.430 | 2.034 | |
NTG | Sex | 0.827 | 1.246 | 0.954 | 1.065 |
Age over 60-year-old | 0.579 | 0.984 | 0.418 | 2.007 | |
Nocturnal dip over 10% | 0.005 | 13.929 | 0.060 | 11.335 | |
Watershed zone | 0.024 | 4.750 | 0.836 | 1.246 | |
Watershed zone with ONH involvement | 0.009 | 8.333 | 0.209 | 3.947 | |
POAG | Sex | 0.757 | 0.713 | 0.189 | 0.152 |
Age over 60-year-old | 0.198 | 0.900 | 0.999 | 7.629 | |
Nocturnal dip over 10% | 0.226 | 3.333 | 0.081 | 13.605 | |
Watershed zone | 0.021 | 8.750 | 0.999 | 2.630 | |
Watershed zone with ONH involvement | 1.000 | 1.500 | 0.999 | 0.000 |