The Effect of Anthocyanoside and Ginkgo Biloba Extract on Normal-Tension Glaucoma According to Presence of Diabetes

Yong Woo Lee; Chul Young Choi; Jeong Hun Bae; Joon Mo Kim

doi:10.3341/jkos.2014.55.8.1174

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Lee, Choi, Bae, and Kim: The Effect of Anthocyanoside and Ginkgo Biloba Extract on Normal-Tension Glaucoma According to Presence of Diabetes

Original Article

J Korean Ophthalmol Soc 2014;55(8):1174-1179.

Published online: 31 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.8.1174

The Effect of Anthocyanoside and Ginkgo Biloba Extract on Normal-Tension Glaucoma According to Presence of Diabetes

Yong Woo Lee, MD, Chul Young Choi, MD, Jeong Hun Bae, MD, Joon Mo Kim, MD

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

Address reprint requests to Joon Mo Kim, MD, Department of Ophthalmology, Kangbuk Samsung Medical Center, #29 Saemunan-ro, Jongno-gu, Seoul 110-746, Korea, Tel: 82-2-2001-2250, Fax: 82-2-2001-2262, E-mail: kjoonmo@dreamwiz.com

Received 14 February 2014 Revised 24 March 2014 Accepted 17 July 2014

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

This study was performed to evaluate the effect of anthocyanoside and ginkgo biloba extract (GBE) in patients with normal tension glaucoma (NTG), according to the presence of diabetes mellitus (DM).

Methods

A chart review of patients with normal tension glaucoma was retrospectively analyzed. All patients underwent a Humphrey visual field (HVF) test and logarithm of the minimal angle of resolution best-corrected visual acuity (log MAR BCVA) was measured over a 6 months period. Changes in mean deviation (MD), pattern standard deviation (PSD) of visual field and log MAR BCVA were compared among anthocyanoside, GBE and no medication (control) groups. Patients were divided according to the presence of DM.

Results

A total of 406 NTG patients, including 151 DM patients, were included in the present study. MD was improved in the an- thocyanoside and GBE groups, but not in the control group. PSD was not significantly different in all groups. BCVA was improved in the anthocyanoside group, but deteriorated in the control group. The results were similar in patients with or without DM. The generalized linear model demonstrated that systemic medication affected changes in visual indices.

Conclusions

The results from the present study suggest that anthocyanoside and GBE may be helpful for improving visual function in some patients with NTG regardless of their DM status.

Keywords: Anthocyanoside, Diabetes mellitus, Ginkgo biloba extract, Normal tension glaucoma

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Table 1.

Characteristics of all patients

	DM(-) (n = 255)	DM (+) (n = 151)	Total (n = 406)
Sex
Male	156	109	265
Female	99	42	141
Age (years)	51.23 ± 12.91	55.13 ± 11.54	52.68 ± 12.55
Mean follow-up (months)	23.74 ± 11.33	27.23 ± 16.77	25.04 ± 13.69
Intraocular pressure (mm Hg)	13.86 ± 3.10	13.84 ± 2.99	13.85 ± 3.06
Blood pressure (mm Hg)
Diastolic	76.70 ± 8.57	78.63 ± 8.68	77.49 ± 8.65
Systolic	118.77 ± 11.51	123.74 ± 12.78	120.62 ± 12.22
Fasting blood sugar (mg/dL)	97.66 ± 12.04	118.14 ± 28.77	109.11 ± 25.07
Hypertension (%)	55 (21.6)	62 (41.1)	131 (31.3)

Values are presented as mean ± SD.

DM = diabetes mellitus.

Table 2.

Patient characteristics and baseline data of treatment group

	DM (-) (n = 255)				DM (+) (n = 151)
	Control (n = 80)	Anthocyanoside (n = 76)	GBE (n = 99)	p-value	Control (n = 36)	Anthocyanoside (n = 83)	GBE (n = 32)	p-value
Sex (%)
Male	48 (60.0)	40 (52.6)	68 (68.7)	0.094^†	25 (69.4)	62 (74.7)	22 (68.8)	0.747^†
Female	32 (40.0)	36 (47.4)	31 (31.3)		11 (30.6)	21 (25.3)	10 (31.3)
Age (years)	50.86 ± 16.48	53.61 ± 9.55	49.71 ± 11.68	0.134^*	56.11 ± 11.43	55.95 ± 11.47	51.91 ± 11.62	0.205^*
Follow-up (months)	22.34 ± 9.77	24.41 ± 11.72	24.36 ± 12.17	0.409^*	24.22 ± 13.54	28.47 ± 17.26	27.41 ± 18.71	0.449^*
BP (mm Hg)
Systolic	119.34 ± 12.32	120.72 ± 10.96	116.82 ± 11.05	0.073^*	123.11 ± 13.50	123.89 ± 11.75	124.06 ± 14.76	0.943^*
Diastolic	77.81 ± 7.50	77.20 ± 9.44	75.41 ± 8.59	0.147^*	79.64 ± 9.73	78.66 ± 8.28	77.41 ± 8.58	0.573^*
FBS (mg/dL)	94.38 ± 8.54	101.59 ± 15.83	96.12 ± 9.05	0.052^*	120.83 ± 26.57	118.08 ± 29.50	115.59 ± 29.94	0.789^*
Hypertension (%)	18 (22.5)	22 (28.9)	15 (15.2)	0.086^†	11 (30.6)	41 (49.4)	10 (31.3)	0.071^†
IOP (mm Hg)	14.16 ± 3.20	13.29 ± 3.00	14.05 ± 3.07	0.157^*	14.83 ± 2.85	13.54 ± 3.09	13.50 ± 2.69	0.199^*
MD (dB)	-3.953 ± 4.788	-4.868 ± 5.393	-4.861 ± 5.334	0.451^*	-4.451 ± 4.490	-6.234 ± 7.116	-5.760 ± 4.929	0.351^*
PSD (dB)	3.726 ± 3.044	4.611 ± 3.930	4.629 ± 4.029	0.205^*	4.798 ± 3.259	5.155 ± 3.750	5.909 ± 4.389	0.467^*
Log MAR BCVA	0.077 ± 0.110	0.076 ± 0.096	0.063 ± 0.087	0.535^*	0.090 ± 0.148	0.110 ± 0.234	0.100 ± 0.185	0.568^*

Values are presented as mean ± SD.

DM = diabetes mellitus; GBE = ginkgo biloba extract; BP = blood pressure; FBS = fasting blood sugar; IOP = intraocular pressure; MD =mean deviation; PSD = pattern standard deviation; log MAR BCVA = logarithm of the minimal angle of resolution best corrected visual acuity.

^* One-way ANOVA;

^† Chi-square test.

Table 3.

Best-corrected visual acuity (BCVA), visual field indices with treatment group

DM (-)	Control (n = 80)			Anthocyanoside (n = 76)			GBE (n = 99)
(n = 255)	Baseline	Follow-up	p-value^*	Baseline	Follow-up	p-value^*	Baseline	Follow-up	p-value^*
MD (dB)	-3.953 (±4.788)	-4.156 (±5.567)	0.654	-4.868 (±5.393)	-4.102 (±5.209)	0.005	-4.861 (±5.704)	-4.013 (±5.360)	0.001
PSD (dB)	3.726 (±3.044)	4.068 (±3.097)	0.154	4.611 (±3.930)	4.494 (±3.943)	0.438	4.629 (±4.029)	4.367 (±4.068)	0.118
log MAR BCVA	0.077 (±0.110)	0.131 (±0.238)	0.022	0.076 (±0.096)	0.057 (±0.082)	0.024	0.063 (±0.087)	0.054 (±0.092)	0.206

DM (+)	Control (n = 36)			Anthocyanoside (n = 83)			GBE (n = 32)
(n = 151)	Baseline	Follow-up	p-value^*	Baseline	Follow-up	p-value^*	Baseline	Follow-up	p-value^*
MD (dB)	-4.451 (±4.490)	-4.261 (±4.436)	0.561	-6.234 (±7.116)	-5.043 (±6.008)	0.003	-5.760 (±4.929) −4.460	(±4.914)	0.025
PSD (dB)	4.798 (±3.259)	4.708 (±3.409)	0.668	5.155 (±3.750)	4.818 (±3.694)	0.053	5.909 (±4.389)	6.030 (±4.353)	0.735
log MAR BCVA	0.090 (±0.148)	0.130 (±0.181)	0.005	0.110 (±0.234)	0.091 (±0.154)	0.011	0.100 (±0.185)	0.103 (±0.233)	0.809

Values are presented as mean ± SD.

DM = diabetes mellitus; GBE = ginkgo biloba extract; MD = mean deviation; PSD = pattern standard deviation; log MAR BCVA = logarithm of the minimal angle of resolution best corrected visual acuity.

^* Paired sample t-test.

Table 4.

Generalized linear model of general and ocular variables and changes in visual indices (after-before)

	Changes of MD		Changes of PSD		Changes of log MAR BCVA
	p-value	Coefficient	p-value	Coefficient	p-value	Coefficient
Sex (Female)	0.818	1.118	0.477	0.801	0.772	1.007
Age	0.002	0.948	0.063	0.545	0.389	0.999
Anthocyanoside	0.019	2.904	0.001	0.382	<0.001	0.913
Ginkgo biloba extract	0.037	2.958	0.063	0.545	0.004	0.932
Hypertension	0.471	1.350	0.308	0.762	0.345	1.019
Diabetes	0.051	2.184	0.120	0.672	0.121	0.971
Intraocular pressure	0.228	1.076	0.533	0.976	0.590	1.002

MD = mean deviation; PSD = pattern standard deviation; log MAR BCVA = logarithm of the minimal angle of resolution best corrected visual acuity.

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