The Association between Corneal Biomechanical Properties and Initial Visual Field Defect Pattern in Normal Tension Glaucoma

Bo Ram Lee; Kyung Eun Han; Kyu Ryong Choi

doi:10.3341/jkos.2017.58.2.178

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Lee, Han, and Choi: The Association between Corneal Biomechanical Properties and Initial Visual Field Defect Pattern in Normal Tension Glaucoma

Original Article

J Korean Ophthalmol Soc 2017;58(2):178-184.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.2.178

The Association between Corneal Biomechanical Properties and Initial Visual Field Defect Pattern in Normal Tension Glaucoma

Bo Ram Lee, M.D., Kyung Eun Han, M.D., Kyu Ryong Choi, M.D., PhD

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

Address reprint requests to Kyu Ryong Choi, MD, PhD Department of Ophthalmology, Ewha Womans University Mokdong Hospital, #1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea Tel: 82-2-2650-5153, Fax: 82-2-2654-4334 E-mail: Ckrey @ewha.ac.kr

Received 4 May 201615 June 2016 Accepted 8 August 2016

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 association between corneal biomechanical properties and initial visual field defect pattern in normal tension glaucoma using an Ocular Response Analyzer (ORA; Reichert Instruments, Depew, NY, USA).

Methods

Forty-one patients with normal tension glaucoma were divided into 2 subgroups, 21 patients with initial paracentral scotomas and 20 patients with initial peripheral scotomas. The corneal biomechanical properties of corneal hysteresis (CH), cor-neal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), corneal-compensated IOP (IOPcc) measured by the ORA, central corneal thickness, and Goldmann applanation tonometry were comparatively analyzed between the 2 groups.

Results

The patients with initial peripheral scotomas were significantly younger than those with initial paracentral scotomas (49.45 ± 13.33 years vs. 58.14 ± 12.49 years, p = 0.035) and showed more myopia (-2.42 ± 2.22 diopter vs. -0.89 ± 2.22 diopter, p = 0.034). The mean CRF was significantly lower in the initial paracentral scotoma group than in the initial peripheral scotoma group. (9.45 ± 1.95 mmHg vs. 10.58 ± 2.05 mmHg; p = 0.041). No significant difference in CH, IOPg, or IOPcc was seen between the groups.

Conclusions

CRF was significantly different between the initial paracentral scotoma group and initial peripheral scotoma group in normal tension glaucoma. Thus, CRF may be useful to predict initial central field loss in normal tension glaucoma.

Keywords: Initial paracentral scotoma, Initial peripheral scotoma, Normal tension glaucoma, Ocular response analysis

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Table 1.

Comparison of corneal biomechanical parameters in normal subjects and NTG patients

Parameters	NTG patients (n = 41)	Normal subjects (n = 40)	p-value^*
Age (years)	53.9 ± 13.48	48.38 ± 13.21	0.066
Untreated IOP (mm Hg)	14.02 ± 3.08	14.30 ± 3.00	0.684
Spherical equivalent (diopter)	-1.51 ± 2.31	-1.68 ± 2.15	0.746
Axial length (mm)	24.85 ± 1.59	24.59 ± 1.27	0.483
CCT (μ m)	551.48 ± 35.73	551.65 ± 34.52	0.984
IOPg (mmHg)	15.08 ± 3.48	16.53 ± 3.87	0.079
IOPcc (mmHg)	14.76 ± 3.11	15.65 ± 2.96	0.186
CRF (mmHg)	10.00 ± 2.06	11.72 ± 2.10	<0.001
CH (mmHg)	10.38 ± 1.76	11.55 ± 1.57	<0.001

Values are presented as mean ± SD unless otherwise indicated.

NTG = normal tension glaucoma; IOP = intraocular pressure; CCT = central corneal thickness; IOPg = Goldman corrected IOP; IOPcc = corneal compensated IOP; CRF= corneal resistant factor; CH = corneal hysteresis.

^* p-value based on Student t-test.

Table 2.

Comparison of clinical characteristics and the perimetric parameters in NTG patients between initial paracentral scotoma and initial peripheral scotoma group

Parameters	Initial paracentral scotoma (n = 21)	Initial peripheral scotoma (n = 20)	p-value
Age (years)	58.14 ± 12.49	49.45 ± 13.33	0.035^*
Sex (Male:Female)	6:15	9:11	0.275^†
Untreated IOP (mmHg)	13.91 ± 3.05	14.15 ± 3.18	0.875^*
Spherical equivalent (diopter)	-0.89 ± 2.22	-2.42 ± 2.22	0.034^*
logMAR visual acuity	0.067 ± 0.12	0.035 ± 0.75	0.354^*
Axial length (mm)	24.35 ± 1.21	25.32 ± 1.80	0.121^*
Family history of glaucoma (n, %)	1 (4.8)	2 (10.0)	0.520^‡
Hypertension (n, %)	6 (28.6)	5 (25.0)	0.796^†
DM (n, %)	1 (4.8)	2 (10.0)	0.520^‡
MD (dB)	-1.27 ± 1.51	-2.39 ± 0.50	0.037^*
PSD (dB)	2.78 ± 1.40	3.39 ± 1.56	0.050^*

Values are presented as mean ± SD unless otherwise indicated.

NTG = normal tension glaucoma; IOP = intraocular pressure; DM = diabetes mellitus; MD = mean deviation; PSD = pattern standard deviation.

^* p-value based on Mann-Whitney test

^† Chi-square test; ^‡ Fisher’s exact test.

Table 3.

Comparison of the relationship between corneal biomechanical properties and initial visual field defect pattern in NTG

Parameters	Initial paracentral scotoma (n = 21)	Initial peripheral scotoma (n = 20)	p-value^*
CCT (μ m)	544.00 ± 32.99	558.53 ± 37.73	0.109
IOPg (mmHg)	14.75 ± 3.51	15.42 ± 3.50	0.442
IOPcc (mmHg)	14.19 ± 2.95	15.36 ± 3.08	0.220
CRF (mmHg)	9.45 ± 1.95	10.58 ± 2.05	0.041
CH (mmHg)	10.06 ± 1.74	10.71 ± 1.77	0.134

Values are presented as mean ± SD unless otherwise indicated.

NTG = normal tension glaucoma; CCT = central corneal thickness; IOPg = Goldman corrected intraocular pressure; IOPcc = corneal com-pensated intraocular pressure; CRF= corneal resistant factor; CH = corneal hysteresis.

^* p-value based on Mann-Whitney test.

Table 4.

Binary logistic regression testing the association between all baseline and intercurrent factors with initial paracentral scotomas

Parameters	Univariable model^*		Multivariable model^†
Parameters	OR (95% CI)	p-value	OR (95% CI)	p-value
Age (years)	1.06 (1.00-1.12)	0.051	-	-
Sex (female)	2.05 (0.56-7.46)	0.278	-	-
Untreated IOP (mmHg)	0.97 (0.80-1.19)	0.796	-	-
Spherical equivalent (diopter)	1.36 (0.98-1.87)	0.063	-	-
Axial length	0.65 (0.37-1.14)	0.135	-	-
Family history of glaucoma	0.45 (0.04-5.39)	0.529	-	-
Presence of hypertension	1.20 (0.30-4.80)	0.797	-	-
Presence of DM	0.45 (0.04-5.39)	0.529	-	-
VF MD (dB)	1.66 (1.05-2.75)	0.032	1.77 (1.05-3.00)	0.033
VF PSD (dB)	0.74 (0.47-1.18)	0.209	-	-
CCT (μ m)	0.99 (0.97-1.01)	0.246	-	-
IOPg (mmHg)	0.95 (0.79-1.13)	0.538	-	-
IOPcc (mmHg)	0.87 (0.71-1.08)	0.217	-	-
CRF (mmHg)	0.71 (0.50-0.99)	0.049	0.69 (0.48-0.99)	0.047
CH (mmHg)	0.80 (0.55-1.16)	0.239	-	-

OR = odds ratio; CI = confidence interval; IOP = intraocular pressure; DM = diabetes mellitus; VF = visual field; MD = mean deviation; PSD = pattern standard deviation; CCT = central corneal thickness; IOPg = Goldman corrected IOP; IOPcc = corneal compensated IOP; CRF= corneal resistant factor; CH = corneal hysteresis.

^* Univariate model including each variable independently

^† Stepwise multivariate model including visual field mean deviation and corneal resist-ance factor along with the other clinical variables.

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