Abstract
Purpose
To investigate the impact of surgical or medical reduction of intraocular pressure (IOP) on progressive normal-tension glaucoma followed up over 15 years.
Methods
Sixty eyes of 60 patients were divided into 3 intervention groups: group 1 (trabeculectomy, n = 17); group 2 (IOP reduction rate ≥15% with prostaglandin analogs, n = 24); and group 3 (IOP reduction rate <15% with prostaglandin analogs, n = 19). The preintervention and postintervention mean deviation (MD) slopes and IOP were compared. Factors associated with the rate of visual field progression were identified by multiple regression analysis.
Results
The mean follow-up was 19.8 years. In group 1, the preintervention and postintervention IOPs were 14.7 ± 1.3 and 9.1 ± 2.0 mmHg, respectively (P < .001, 38% reduction). The MD slope decreased significantly after trabeculectomy (−0.86 ± 0.51 versus −0.19 ± 0.20 dB/y; P < .001). In group 2, the preintervention and postintervention IOPs were 14.7 ± 1.5 and 11.7 ± 1.2 mmHg, respectively (P < 0.001, 20% reduction), with significant differences in the MD slope (−0.52 ± 0.37 versus −0.31 ± 0.30 dB/y; P = .019). In group 3, the preintervention and postintervention IOPs were 14.4 ± 1.8 and 13.2 ± 1.6 mmHg, respectively (P < 0.001, 8% reduction), with no differences in the MD slope (−0.40 ± 0.27 versus −0.50 ± 0.65 dB/y; P > .05). Multiple regression analysis showed that the average IOP, IOP reduction rate, and preintervention MD slope were related to the extent of the postintervention reduction in the MD slope. The difference in the preintervention and postintervention MD slopes significantly correlated with the rate of IOP reduction (r = 0.559, P < .001).
Conclusions
A pressure-dependent maintenance effect of the visual field was confirmed in progressive normal-tension glaucoma.
Similar content being viewed by others
References
Collaborative Normal-Tension Glaucoma Study Group. The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma. Am J Ophthalmol. 1998;126:498–505.
Drance S, Anderson DR, Schulzer M, Collaborative Normal-Tension Glaucoma Study Group. Risk factors for progression of visual field abnormalities in normal-tension glaucoma. Am J Ophthalmol. 2001;131:699–708.
Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M, et al. Reduction of intraocular pressure and glaucoma progression: results from the early manifest glaucoma trial. Arch Ophthalmol. 2002;120:1268–79.
Leske MC, Heijl A, Hussein M, Bengtsson B, Hyman L, Komaroff E, et al. Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial. Arch Ophthalmol. 2003;121:48–56.
Leske MC, Heijl A, Hyman L, Bengtsson B, Dong L, Yang Z, et al. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology. 2007;114:1965–72.
Kim M, Kim DM, Park KH, Kim TW, Jeoung JW, Kim SH. Intraocular pressure reduction with topical medications and progression of normal-tension glaucoma: a 12-year mean follow-up study. Acta Ophthalmol. 2013;91:270–5.
Aoyama A, Ishida K, Sawada A, Yamamoto T. Target intraocular pressure for stability of visual field loss progression in normal-tension glaucoma. Jpn J Ophthalmol. 2010;54:117–23.
Heijl A, Bengtsson B, Hyman L, Leske MC, Early Manifest Glaucoma Trial G. Natural history of open-angle glaucoma. Ophthalmology. 2009;116:2271–6.
De Moraes CG, Liebmann JM, Greenfield DS, Gardiner SK, Ritch R, Krupin T, et al. Risk factors for visual field progression in the low-pressure glaucoma treatment study. Am J Ophthalmol. 2012;154:702–11.
Membrey WL, Poinoosawmy DP, Bunce C, Fitzke FW, Hitchings RA. Comparison of visual field progression in patients with normal pressure glaucoma between eyes with and without visual field loss that threatens fixation. Br J Ophthalmol. 2000;84:1154–8.
Fukuchi T, Yoshino T, Sawada H, Seki M, Togano T, Tanaka T, et al. The relationship between the mean deviation slope and follow-up intraocular pressure in open-angle glaucoma patients. J Glaucoma. 2013;22:689–97.
Spry PG, Johnson CA. Identification of progressive glaucomatous visual field loss. Surv Ophthalmology. 2002;47:158–73.
Anderson DR, Drance SM, Schulzer M, Collaborative Normal-Tension Glaucoma Study G. Natural history of normal-tension glaucoma. Ophthalmology. 2001;108:247–53.
Sakata R, Aihara M, Murata H, Mayama C, Tomidokoro A, Iwase A, et al. Contributing factors for progression of visual field loss in normal-tension glaucoma patients with medical treatment. J Glaucoma. 2013;22:250–4.
Ahrlich KG, De Moraes CG, Teng CC, Prata TS, Tello C, Ritch R, et al. Visual field progression differences between normal-tension and exfoliative high-tension glaucoma. IOVS. 2010;51:1458–63.
Tomita G, Araie M, Kitazawa Y, Tsukahara S. A three-year prospective, randomized and open comparison between latanoprost and timolol in Japanese normal-tension glaucoma patients. Eye. 2004;18:984–9.
Araie M, Shirato S, Yamazaki Y, Kitazawa Y, Ohashi Y, Nipradilol-Timolol Study G. Visual field loss in patients with normal-tension glaucoma under topical nipradilol or timolol: subgroup and subfield analyses of the nipradilol-timolol study. Jpn J Ophthalmol. 2010;54:278–85.
Heijl A, Buchholz P, Norrgren G, Bengtsson B. Rates of visual field progression in clinical glaucoma care. Acta Ophthalmol. 2013;91:406–12.
European Glaucoma Society. Terminology and guidelines for glaucoma. 4th ed. Savona: European Glaucoma Society Fundation; 2014.
Choi YJ, Kim M, Park KH, Kim DM, Kim SH. The risk of newly developed visual impairment in treated normal-tension glaucoma: 10-year follow-up. Acta Ophthalmol. 2014;92:644–9.
Lee J, Sohn SW, Kee C. Effect of Ginkgo biloba extract on visual field progression in normal tension glaucoma. J Glaucoma. 2013;22:780–4.
Komori S, Ishida K, Yamamoto T. Results of long-term monitoring of normal-tension glaucoma patients receiving medical therapy: results of an 18-year follow-up. Graefes Arch Clin Exp Ophthalmol. 2014;252:1963–70.
Cheng JW, Cai JP, Wei RL. Meta-analysis of medical intervention for normal tension glaucoma. Ophthalmology. 2009;116:1243–9.
Anderson DR, Patella VM. Interpretation of a single field. Automated static perimetry. St. Louis: Mosby; 1999. p. 121–90.
Nakazawa T, Shimura M, Ryu M, Himori N, Nitta F, Omodaka K, et al. Progression of visual field defects in eyes with different optic disc appearances in patients with normal tension glaucoma. J Glaucoma. 2012;21:426–30.
Fukuchi T, Yoshino T, Sawada H, Seki M, Togano T, Tanaka T, et al. Progression rate of total, and upper and lower visual field defects in open-angle glaucoma patients. Clin Ophthalmol. 2010;4:1315–23.
Shigeeda T, Tomidokoro A, Araie M, Koseki N, Yamamoto S. Long-term follow-up of visual field progression after trabeculectomy in progressive normal-tension glaucoma. Ophthalmology. 2002;109:766–70.
Chauhan BC, Malik R, Shuba LM, Rafuse PE, Nicolela MT, Artes PH. Rates of glaucomatous visual field change in a large clinical population. IOVS. 2014;55:4135–43.
Chauhan BC, Garway-Heath DF, Goni FJ, Rossetti L, Bengtsson B, Viswanathan AC, et al. Practical recommendations for measuring rates of visual field change in glaucoma. Br J Ophthalmol. 2008;92:569–73.
Krupin T, Liebmann JM, Greenfield DS, Ritch R, Gardiner S, Low-Pressure Glaucoma Study G. A randomized trial of brimonidine versus timolol in preserving visual function: results from the Low-Pressure Glaucoma Treatment Study. Am J Ophthalmol. 2011;151:671–81.
The AGIS Investigators. Advanced Glaucoma Intervention Study: 2. Visual field test scoring and reliability. Ophthalmology. 1994;101:1445–55.
The AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol. 2000;130:429–40.
The AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): 12. Baseline risk factors for sustained loss of visual field and visual acuity in patients with advanced glaucoma. Am J Ophthalmol. 2002;134:499–512.
Ederer F, Gaasterland DA, Dally LG, Kim J, VanVeldhuisen PC, Blackwell B, et al. The Advanced Glaucoma Intervention Study (AGIS): 13. Comparison of treatment outcomes within race: 10-year results. Ophthalmology. 2004;111:651–64.
Caprioli J, Coleman AL. Intraocular pressure fluctuation a risk factor for visual field progression at low intraocular pressures in the advanced glaucoma intervention study. Ophthalmology. 2008;115:1123–9.
Gillespie BW, Musch DC, Guire KE, Mills RP, Lichter PR, Janz NK, et al. The collaborative initial glaucoma treatment study: baseline visual field and test-retest variability. IOVS. 2003;44:2613–20.
Musch DC, Gillespie BW, Lichter PR, Niziol LM, Janz NK, Investigators CS. Visual field progression in the Collaborative Initial Glaucoma Treatment Study: the impact of treatment and other baseline factors. Ophthalmology. 2009;116:200–7.
Musch DC, Gillespie BW, Niziol LM, Lichter PR, Varma R, Group CS. Intraocular pressure control and long-term visual field loss in the Collaborative Initial Glaucoma Treatment Study. Ophthalmology. 2011;118:1766–73.
Nakagami T, Yamazaki Y, Hayamizu F. Prognostic factors for progression of visual field damage in patients with normal-tension glaucoma. Jpn J Ophthalmol. 2006;50:38–43.
Folgar FA, de Moraes CG, Prata TS, Teng CC, Tello C, Ritch R, et al. Glaucoma surgery decreases the rates of localized and global visual field progression. Am J Ophthalmol. 2010;149:258–64.
Higashide T, Ohkubo S, Sugimoto Y, Kiuchi Y, Sugiyama K. Persistent hypotony after trabeculectomy: incidence and associated factors in the Collaborative Bleb-Related Infection Incidence and Treatment Study. Jpn J Ophthalmol. 2016;60:309–18.
Ma KT, Kim CY, Seong GJ, Lee SH, Park JW, Ha SJ, et al. Intraocular pressure reduction in normal-tension glaucoma patients in South Korea. Int Ophthalmol. 2011;31:355–61.
Lee J, Kong M, Kim J, Kee C. Comparison of visual field progression between relatively low and high intraocular pressure groups in normal tension glaucoma patients. J Glaucoma. 2014;23:553–60.
Bhardwaj N, Niles PI, Greenfield DS, Hymowitz M, Sehi M, Feuer WJ, et al. The impact of surgical intraocular pressure reduction on visual function using various criteria to define visual field progression. J Glaucoma. 2013;22:632–7.
Acknowledgements
This study was supported in part by JSPS Kakenhi Grant No. JP 26462634.
Conflicts of interest
S. Oie, None; K. Ishida, None; T. Yamamoto, Grants (Alcon Japan, MSD Japan, Otsuka, Pfizer Japan, Santen, Senju), Consultant fees (Alcon Japan, Kowa, Otsuka, Pfizer Japan, Rohto, Senju), Lecture fees (Alcon Japan, AMO Japan, CREWT Medical Systems, Johnson & Johnson, Kowa, MSD Japan, Novartis Pharma, Otsuka, Pfizer Japan, R-Tech Ueno, Santen, Senju).
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Oie, S., Ishida, K. & Yamamoto, T. Impact of intraocular pressure reduction on visual field progression in normal-tension glaucoma followed up over 15 years. Jpn J Ophthalmol 61, 314–323 (2017). https://doi.org/10.1007/s10384-017-0519-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10384-017-0519-8