Baseline Central Visual Field Defect as a Risk Factor For NTG Progression: A 5-Year Prospective Study

Abstract

Precis: This 5-year follow-up study on normal-tension glaucoma (NTG) patients demonstrated that those with baseline central visual field (VF) defect progress at a more increased rate compared with those with peripheral field defect. Purpose: The purpose of this study was to investigate the clinical characteristics, including 24-hour ocular perfusion pressure and risk of progression in patients with baseline central VF defect, as compared with those with peripheral VF defect in NTG. Design: This was a prospective, longitudinal study. Methods: A total of 65 NTG patients who completed 5 years of follow-up were included in this study. All the enrolled patients underwent baseline 24-hour intraocular pressure and blood pressure monitoring via 2-hourly measurements in their habitual position and had ≥5 reliable VF tests during the 5-year follow-up. Patients were assigned to two groups on the basis of VF defect locations at baseline, the central 10 degrees, and the peripheral 10- to 24-degree area. Modified Anderson criteria were used to assess global VF progression over 5 years. Kaplan-Meier analyses were used to compare the elapsed time of confirmed VF progression in the two groups. Hazard ratios for the association between clinical risk factors and VF progression were obtained by using Cox proportional hazards models. Results: There were no significant differences between the patients with baseline central and peripheral VF defects in terms of demography, clinical, ocular and systemic hemodynamic factors. Eyes with baseline defects involving the central fields progressed faster (difference: βcentral=−0.78 dB/y, 95% confidence interval=−0.22 to −1.33, P=0.007) and have 3.56 times higher hazard of progressing (95% confidence interval=1.17-10.82, P=0.025) than those with only peripheral defects. Conclusion: NTG patients with baseline central VF involvement are at increased risk of progression compared with those with peripheral VF defect.

Determinants of vessel defects in superficial and deep vascular layers in normal-tension glaucoma using optical coherence tomography angiography

“…Nevertheless, some studies reported the opposed findings; presence of hemodynamic turbulence has little to do with the location of VF defects 42 , and no significant differences were found between NTG and high tension glaucoma regarding the slopes or depths of the VF defect 43 . Moreover, no difference in systemic and vascular factors between patients with paracentral and peripheral VF defects was found 44 , 45 . Park et al 46 found totally overturned results that eyes with paracentral VFD had distinctive ocular and systemic hemodynamic features.…”

Factors Associated with Elevated Tumor Necrosis Factor-α in Aqueous Humor of Patients with Open-Angle Glaucoma

“…Only central scotoma was statistically significant in the multivariate analysis. Central scotoma has been associated with vascular instability and increased risk of progression especially in NTG patients [ 25 , 26 , 27 , 28 ]. Glaucoma patients with central scotoma have been shown to have lower vascular density and greater fluctuation in vascular density as measured by OCT angiography [ 26 ].…”

Investigation of progression pattern and associated risk factors in glaucoma patients with initial paracentral scotomas using Humphrey 10-2

“…The present study added that imaging the optic disc using OCT-A may also be important to monitor initial paracentral scotomas in glaucoma patients. Initial paracentral scotoma has been reported to be a factor related to future glaucoma progression 30 , 31 . The presence of central VF damage at baseline was significantly associated with more rapid global progression.…”