Baseline Systolic versus Diastolic Blood Pressure Dip and Subsequent Visual Field Progression in Normal-Tension Glaucoma.

PURPOSE: To investigate the impact of systolic and diastolic blood pressure (DBP) dip at baseline on subsequent visual field (VF) progression in eyes with normal-tension glaucoma (NTG). DESIGN: Prospective cohort study. PARTICIPANTS: This study included 119 eyes of 119 newly diagnosed NTG patients followed up for at least 2 years (average, 40.4±16.9 months). METHODS: All participants underwent baseline 24-hour ambulatory blood pressure (BP) monitoring and measurements of intraocular pressure (IOP) and at least 5 serial VF examinations. Participants were followed up as outpatients at 4- to 6-month intervals. Visual field progression was defined according to Early Manifest Glaucoma Trial criteria. The associations of VF progression with systolic BP (SBP) and DBP measured during the day and at night and other clinical variables were analyzed. MAIN OUTCOME MEASURES: Factors associated with VF progression over time. RESULTS: During follow-up, 41 eyes (34%) showed VF progression. In the multivariate Cox regression model, lower nighttime trough DBP (hazard ratio, 0.953; P = 0.023) and greater nighttime DBP dip area (time multiplied by nighttime DBP > 10 mmHg less than mean daytime DBP; hazard ratio, 1.017; P = 0.003) at baseline were significant predictors of subsequent VF progression. None of the SBP parameters was associated with VF progression. Nocturnal DBP dip showed a greater association with VF progression than SBP dip. CONCLUSIONS: Nocturnal trough DBP and DBP dip area at baseline are significant predictors of subsequent VF progression in NTG. Nocturnal DBP dip may be more relevant to future VF progression than SBP dip in NTG eyes.

Optic disc tilt direction affects regional visual field progression rates in myopic eyes with open-angle glaucoma.

PURPOSE: To compare global and regional visual field (VF) progression rates and determine clinical factors associated with rapid VF progression in myopic patients with open-angle glaucoma (OAG) with different disc tilt directions. METHODS: The medical records of 182 eyes from 182 myopic OAG patients with progressive VF deterioration during follow-up were analyzed. The rates of change in the mean thresholds of the global and regional VF areas of the horizontal and vertical disc tilt (HDT and VDT) groups were compared using a linear mixed model after controlling for confounding covariates. Clinical factors associated with rapid VF progression in global and regional VF areas were investigated. RESULTS: The VDT group showed significantly faster VF progression at inferior regional zones than the HDT group (P < 0.05). Based on a multivariate linear mixed model, VDT was associated with faster bi-hemifield VF progression in the GHT map, whereas HDT was associated with faster single-hemifield VF progression. CONCLUSIONS: Myopic OAG eyes show significantly different regional VF progression rates according to disc tilt direction. VDT is an independent predictor of a rapid rate of regional VF progression in both hemifields, whereas HDT predicts rapid regional VF progression in a single hemifield.

Optic disc torsion presenting as unilateral glaucomatous-appearing visual field defect in young myopic Korean eyes.

PURPOSE: To investigate the ocular features of companion eyes in an attempt to find eye-related factors that are associated with unilateral glaucomatous-appearing visual field (VF) defects in young myopic subjects. DESIGN: Retrospective, cross-sectional study. PARTICIPANTS: Thirty-nine patients (age range, 20-50 years) with unilateral glaucomatous-appearing VF defect and myopia. METHODS: A comparison was performed between VF-affected eyes and contralateral normal eyes. Optic disc torsion and tilt ratio were measured from disc photographs. Logistic regression analysis and linear regression analysis were performed to investigate various ocular parameters, including torsion degree and tilt ratio, that may be associated with the presence and severity of VF defect. MAIN OUTCOME MEASURES: Torsion degree, tilt ratio, and the severity of VF defect. RESULTS: Optic disc torsion degree (16.63±9.78°) of VF-affected eyes was statistically greater than that of the normal contralateral eyes (8.69±7.28°; P<0.001). Optic disc torsion was more prevalent in VF-affected eyes (66.6%) than in normal contralateral eyes (15.3%; P<0.001). In the multivariate analysis, the degree of optic disc torsion was associated significantly with the presence of VF defect (P = 0.005). The torsion degree (P = 0.006) and retinal nerve fiber layer thickness (P = 0.004) were associated significantly with the severity of VF defect. CONCLUSIONS: The prevalence and degree of optic disc torsion in the VF-affected eyes were significantly greater than those of contralateral normal eyes in unilateral, young, myopic patients with glaucomatous-appearing VF defect. Optic disc torsion should be considered in the presence of unilateral glaucomatous-appearing VF defect in young myopic eyes.

Bimatoprost 0.01% in treatment-naïve patients with open-angle glaucoma or ocular hypertension: an observational study in the Korean clinical setting.

BACKGROUND: This study evaluates the efficacy and tolerability (ie, occurrence and severity of hyperemia) of bimatoprost 0.01% in treatment-naïve patients with open-angle glaucoma (OAG) or ocular hypertension in the Korean clinical setting. METHODS: In this multicenter, open-label, observational study, treatment-naïve patients with OAG, including patients with normal-tension glaucoma (NTG, defined as IOP ≤21 mm Hg), or ocular hypertension received bimatoprost 0.01% once daily. Hyperemia was assessed at baseline and weeks 6 and 12, graded by a masked evaluator using a photonumeric scale (0, +0.5, +1, +2, +3), and grouped as (0 to +1) and (+2 to +3). Shifts between groupings were reported as no change, improved ([+2 to +3] to [0 to +1]), or worsened ([0 to +1] to [+2 to +3]). Other adverse events were monitored. Mean IOP changes from baseline at weeks 6 and 12 were reported. Supplemental analyses were conducted for IOPs >21 versus ≤21 mm Hg. RESULTS: Of 295 treatment-naïve patients included in the intent-to-treat/safety population, 73 (24.7%) had baseline IOP >21 mm Hg (mean, 25.7 ± 5.0 mm Hg) and 222 (75.3%) had baseline IOP ≤21 mm Hg (mean, 16.3 ± 3.0 mm Hg); 96.3% had hyperemia graded none (36.3%) to mild (17.3%). At week 12, hyperemia was graded none to mild in 83.7% (n = 220). Worsening occurred in 12.3% of patients by week 6 and 12.7% by week 12. Small improvements occurred in 0.8% and 0.5% of patients at weeks 6 and 12, respectively. Hyperemia scores were generally low and the majority of patients had no change in severity during the study. Mean IOP at weeks 6 and 12 was reduced to 16.4 ± 4.0 mm Hg (-34.5%; P < 0.0001) and 16.7 ± 3.9 mm Hg (-32.0%; P < 0.001) in the baseline-IOP >21 mm Hg group versus 13.3 ± 2.6 mm Hg (-17.8%; P < 0.001) and 13.7 ± 2.8 mm Hg (-15.9%; P < 0.001) in the baseline-IOP ≤21 mm Hg group, respectively. CONCLUSIONS: In treatment-naïve patients, bimatoprost 0.01% induced low shifts in worsening of hyperemia and significant reductions in IOP, regardless of baseline IOP. CLINICAL TRIAL REGISTRATION NUMBER: NCT01594970.

Progressive Macular Vessel Density Loss and Visual Field Progression in Open-angle Glaucoma Eyes with Central Visual Field Damage.

PURPOSE: To investigate the association between the longitudinal changes in both macular vessel density (mVD) and macular ganglion cell-inner plexiform layer thickness (mGCIPLT) and visual field (VF) progression (including central VF progression) in open-angle glaucoma (OAG) patients with central visual field (CVF) damage at different glaucoma stages. DESIGN: Retrospective longitudinal study. PARTICIPANTS: This study enrolled 223 OAG eyes with CVF loss at baseline classified as early-to-moderate (133 eyes) or advanced (90 eyes) stage based on the VF mean deviation (MD) (-10 dB). METHODS: Serial mVDs at parafoveal and perifoveal sectors and mGCIPLT measurements were obtained using OCT angiography and OCT during a mean follow-up of 3.5 years. Visual field progression was determined using both the event- and trend-based analyses during follow-up. MAIN OUTCOME MEASURES: Linear mixed-effects models were used to compare the rates of change in each parameter between VF progressors and nonprogressors. Logistic regression analyses were performed to determine the risk factors for VF progression. RESULTS: In early-to-moderate stage, progressors showed significantly faster rates of change in the mGCIPLT (-1.02 vs. -0.47 µm/year), parafoveal (-1.12 vs. -0.40%/year), and perifoveal mVDs (-0.83 vs. -0.44%/year) than nonprogressors (all P < 0.05). In advanced stage cases, only the rates of change in mVDs (parafoveal: -1.47 vs. -0.44%/year; perifoveal: -1.04 vs. -0.27%/year; all P < 0.05) showed significant differences between the groups. By multivariable logistic regression analyses, the faster rate of mVD loss was a predictor of VF progression regardless of glaucoma stage, while the rate of mGCIPLT loss was significantly associated with VF progression only in early-to-moderate stage cases. CONCLUSIONS: Progressive mVD loss is significantly associated with VF progression (including central VF progression) in the OAG eyes with CVF loss regardless of the glaucoma stage. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Utility of targeted mean total deviation trend analysis for detecting progressive visual field changes in early-to-moderate stage glaucoma.

OBJECTIVES: To evaluate the clinical utility of trend-based analysis of the targeted mean total deviation (TMTD) by comparing its rates of visual field (VF) change and sensitivities of detecting VF progression with those of the mean total deviation (mTD) in the global and hemifield VF area in early to-moderate glaucoma patients. METHODS: A single eye from 139 open-angle glaucoma patients with hemifield VF defects and a minimum two year follow-up were retrospectively evaluated. The TMTD was estimated by averaging the total deviation (TD) values after excluding VF points that had a threshold sensitivity of <0 dB in three baseline tests, and the mTD by averaging the entire VF TD values. The study patients were classified as VF progressors vs. non-progressors using both event- and trend-based analysis. The rates of change and ratios of progression detection were compared between TMTD and mTD. RESULTS: This study included 49 VF progressors and 90 non-progressors. Slopes for the global and VF-affected hemifield TMTD were significantly faster than those for the mTD in each subgroup and in the entire cohort (P < 0.001). Trend-based TMTD analysis detected VF progression in greater proportion than either trend-based mTD or event-based analysis (38.1% vs. 30.2% vs. 27.3%, respectively: VF affected hemifields). CONCLUSIONS: The rates of change in the TMTD are significantly faster than those for the mTD globally and in the VF-affected hemifields. Trend-based TMTD analysis shows greater sensitivity for detecting VF progression than trend-based mTD or event-based analysis in early-to-moderate glaucoma patients with hemifield VF loss.

Comparison of the Circumpapillary Structure-Function and Vasculature-Function Relationships at Different Glaucoma Stages Using Longitudinal Data.

Purpose: This study investigated the global and regional correlations between longitudinal structure-function (S-F) and vasculature-function (V-F) data using circumpapillary retinal nerve fiber layer thickness (cpRNFLT) measurements from optical coherence tomography (OCT), circumpapillary vessel density (cpVD) from OCT angiography (OCTA), and the corresponding visual field mean sensitivities at different glaucoma stages. Methods: A total of 107 eyes from 107 glaucoma patients with progressive visual field (VF) changes followed up for an average of 3.33 ± 1.39 years were enrolled, including early-to-moderate (51 eyes) and advanced (56 eyes) stages. The rates of longitudinal change in the VF mean deviation (MD), cpRNFLT, and cpVD were evaluated using linear mixed-effects models and compared between different glaucoma stages. Longitudinal global and regional S-F and V-F relationships were assessed by repeated measures correlation analysis by glaucoma stage. Results: No significant differences were found in the rates of VF MD and cpVD changes (P > 0.05) between the two glaucoma stage groups. CpRNFLT decreased more rapidly in the early-to-moderate stage group (P < 0.001) in which significant longitudinal global and regional correlations were found in both S-F and V-F relationships (all P < 0.05), except for the nasal sector. Significant global and regional correlations were only found in V-F relationship in advanced stage cases (all P < 0.05). Conclusions: Significant longitudinal V-F relationships exist globally and regionally regardless of glaucoma stage but no longitudinal S-F relationship is present in advanced glaucoma. Longitudinal follow-up of cpVD parameters may be useful for monitoring glaucomatous VF progression at all disease stages.

Peripapillary Versus Macular Thinning to Detect Progression According to Initial Visual Field Loss Location in Normal-Tension Glaucoma.

PURPOSE: To investigate the predictive capabilities of peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) thinning to detect visual field (VF) progression in normal-tension glaucoma patients with an initial parafoveal scotoma (IPFS) or nasal step (INS). DESIGN: Retrospective cohort study. METHODS: A total of 185 early-stage glaucoma eyes, followed for 10 years, were retrospectively stratified into IPFS and INS groups. Progressive pRNFL and mGCIPL thinning were assessed using spectral-domain optical coherence tomography and VF progression using both event- or trend-based analysis. Kaplan-Meier survival analysis compared VF survival in each VF phenotype with or without progressive pRNFL and mGCIPL thinning. Cox proportional regression analysis identified VF progression factors. RESULTS: VF progression was detected in 42 IPFS (n = 86) and 47 INS (n = 99) eyes. Among VF progressors, pRNFL thinning was significantly faster in INS group compared to IPFS group (P < .01), while mGCIPL thinning was similar (P = .16). At 5 years, eyes with progressive mGCIPL thinning showed significantly lower VF survival in both VF phenotypes (all P < .05). Progressive pRNFL thinning showed significantly lower VF survival only in INS eyes (P = .015). Cox multivariate regression revealed that mGCIPL thinning predicted subsequent VF progression in IPFS eyes, while mGCIPL and pRNFL thinning had significant associations with VF progression in INS eyes. CONCLUSIONS: mGCIPL outperforms pRNFL at early follow-up in detecting VF progression in IPFS eyes but not INS eyes. Appropriate selection of structural parameters (mGCIPL vs. pRNFL) maximizes early VF progression detection according to initial VF defect location.

Ocular pulse amplitude as a dynamic parameter and its relationship with 24-h intraocular pressure and blood pressure in glaucoma.

Abnormal ocular blood flow (OBF) has been suspected as one of the underlying mechanisms of glaucoma. The ocular pulse amplitude (OPA) is considered a possible surrogate parameter for ocular blood flow (OBF) measurement and has been studied in its association with glaucoma. Although there have been several studies that reported various ocular and systemic factors in association with OPA, all of these studies were based on a single measurement of these factors as well as OPA. The purpose of this study was to determine the 24-h (h) dynamic variability and any associations between OPA and intraocular pressure (IOP) and blood pressure (BP) variables using 24-h data collected from untreated patients with normal-tension glaucoma (NTG). One hundred and forty-four patients with NTG were consecutively enrolled. All patients underwent 24-h monitoring of IOP, OPA, and BP variables. A cosinor model was used to describe the patterns and statistical significance of the 24-h OPA rhythm, as well as the IOP and BP variables. Associations between 24-h OPA data, IOP and BP variables, and ocular and demographic factors were also assessed using the generalized estimating equation. Over the course of 24-h, OPA (p = 0.007) demonstrated significant dynamic diurnal rhythms that were similar to the other dynamic variables (all p < 0.05). Based on the 24-h data, IOP (p < 0.001), arterial pulse pressure (p = 0.034), and the spherical equivalent (p < 0.001) positively correlated with the OPA, whilst male sex (p < 0.001) negatively correlated with the OPA. These results indicate that OPA is primarily influenced by IOP as well as arterial pulse pressure, spherical equivalent, and gender. In conclusion, OPA is a dynamic ocular parameter that demonstrates a 24-h short-time fluctuation in NTG patients.

The glaucoma detection capability of spectral-domain OCT and GDx-VCC deviation maps in early glaucoma patients with localized visual field defects.

PURPOSE: To evaluate and compare the glaucoma detection capabilities afforded by retinal nerve fiber layer (RNFL) thickness and deviation maps obtained using Cirrus spectral domain optical coherence tomography (Cirrus OCT), and GDx employing variable corneal compensation (GDx-VCC) in glaucoma patients with early, localized visual field (VF) loss. METHODS: This prospective controlled, comparative study was performed on 42 eyes with localized VF defects, and 42 age/refractive error-matched healthy eyes. All participants were imaged by both imaging devices at the same visit. The area of the RNFL defect in each deviation map, corresponding to a VF defect, was analyzed by direct counting of color-coded superpixels in each device. Receiver operating characteristic (ROC) curves were constructed and compared between Cirrus OCT and GDx-VCC. RESULTS: The areas under the ROCs (AUCs) of RNFL quadrant thicknesses in hemifields with visual field (VF) defects did not differ significantly (Cirrus OCT; 0.961, GDx-VCC; 0.919, P = 0.07). However, Cirrus OCT afforded a better diagnostic ability, by deviation map analysis, than did GDx-VCC (0.972 vs 0.887, P = 0.02). CONCLUSIONS: The RNFL thicknesses assessed by either Cirrus OCT or GDx-VCC were comparable in terms of early glaucoma diagnostic capability. However, when areas containing RNFL defects were analyzed via deviation mapping, Cirrus OCT was better than GDx-VCC.

Detection of macular ganglion cell loss in preperimetric glaucoma patients with localized retinal nerve fibre defects by spectral-domain optical coherence tomography.

BACKGROUND: To evaluate and compare the utility of ganglion cell complex with peripapillary retinal nerve fibre layer and optic nerve head measurements for detection of localized defects in patients with preperimetric glaucoma using spectral-domain optical coherence tomography. DESIGN: Prospective study. PARTICIPANTS: Preperimetric glaucoma patients. METHODS: A total of 105 eyes with preperimetric glaucoma and 68 age- and refractive error-matched control eyes were enrolled. The ability to detect localized retinal nerve fibre layer defects by RTVue-100 spectral-domain optical coherence tomography (Optovue, Inc., Fremont, CA, USA) was assessed calculating the areas under receiver operating characteristic curves. MAIN OUTCOME MEASURES: The ability to detect localized retinal nerve fibre layer defects by spectral-domain optical coherence tomography. RESULTS: Global volume loss and superior ganglion cell complex thickness showed the largest area under receiver operating characteristic curve values (both areas under receiver operating characteristic curves 0.84, P < 0.001) among ganglion cell complex parameters. Average peripapillary retinal nerve fibre layer thickness afforded the best diagnostic capability (area under receiver operating characteristic curve 0.89, P < 0.001), whereas among optic nerve head parameters, the horizontal cup:disc ratio yielded the highest area under receiver operating characteristic curve (0.85, P < 0.001). No statistical difference was evident between the areas under receiver operating characteristic curves of the most informative parameters when the data were gathered from the three different sites (ganglion cell complex, peripapillary retinal nerve fibre layer, and optic nerve head) (P > 0.02). CONCLUSIONS: Ganglion cell complex thickness was significantly reduced in eyes with preperimetric glaucoma. Ganglion cell complex imaging using spectral-domain optical coherence tomography may be a useful ancillary modality for detection of early macular changes in glaucomatous eyes with localized retinal nerve fibre layer defects.

Association of superficial macular vessel density with visual field progression in open-angle glaucoma with central visual field damage.

Identifying the clinical relevance of superficial versus deep layer macular vessel density (mVD) in glaucoma is important for monitoring glaucoma patients. Our current retrospective longitudinal study investigated the association of superficial and deep layer mVD parameters with glaucomatous visual field (VF) progression in mild to moderate open-angle glaucoma (OAG) eyes with central visual field (CVF) damage. Serial optical coherence tomography (OCT) angiography-derived mVD measurements were obtained in 182 mild to moderate OAG eyes (mean deviation ≥ -10 decibels). Forty-eight eyes (26.4%) showed VF progression during a mean follow-up of 3.5 years. The parafoveal and perifoveal mVDs of both superficial and deep layers showed significantly faster reduction rates in the VF progressors than in the non-progressors according to linear mixed effects models (P < 0.05). Cox and linear regression analyses showed that greater reduction rates of both the superficial layer parafoveal and perifoveal mVDs, but not their deep layer counterparts, were significant predictors of VF progression and faster VF loss (P < 0.05). In conclusion, faster rates of change in superficial but not deep layer mVD parameters are significantly associated with subsequent VF progression and faster VF deterioration in mild to moderate OAG eyes with CVF damage.

Association of baseline optical coherence tomography angiography with the development of glaucomatous visual field defects in preperimetric glaucoma eyes.

AIMS: To evaluate whether baseline vessel density (VD) parameters derived from optical coherence tomography angiography (OCT-A) is associated with the development of glaucomatous visual field (VF) defects in preperimetric glaucoma (PPG) patients. METHODS: One eye from each of 200 consecutive PPG patients with a normal standard automated perimetry and OCT-A at baseline was retrospectively analysed. OCT-A was used to measure the circumpapillary VD (cpVD) and the parafoveal and perifoveal VD. The retinal nerve fibre layer (RNFL) and macular ganglion cell-inner plexiform layer thicknesses were measured as reference standards. Two patient groups were stratified based on the development of repeatable glaucomatous VF loss. A Cox proportional hazards model was constructed to determine the predictive ability of OCT-A parameters for VF defects. The correlation between these baseline OCT-A parameters and the rate of global VF sensitivity loss (dB/year) was calculated using linear regression analysis. RESULTS: During a 3.1-year average follow-up period, 18 eyes (9.0%) developed glaucomatous VF defects. At baseline, the lower inferior temporal cpVD (HR (95% CI)=0.934 (0.883 to 0.988); p=0.017) and thinner inferior RNFL (HR (95% CI)=0.895 (0.839 to 0.956); p=0.001) were predictive of glaucomatous VF loss. A lower inferior temporal cpVD and thinner RNFL at baseline were associated with faster rate of global VF sensitivity loss (ß=0.015; p=0.001). CONCLUSION: In PPG eyes, a lower baseline inferior temporal cpVD is significantly associated with glaucomatous VF defect development and a faster rate of global VF loss.

Foveal avascular zone vessel density is associated with visual field progression in early-stage glaucoma eyes with central visual field damage.

We investigated the relationship between foveal avascular zone (FAZ)-related parameters, assessed by optical coherence tomography angiography (OCT-A), and visual field (VF) progression in early-stage open-angle glaucoma (OAG) eyes with central visual field (CVF) defects. Early-stage glaucoma eyes [VF mean deviation (MD) ≥ - 6 dB] with CVF defects were included. The rates of longitudinal change in FAZ-related parameters and structural parameters were evaluated and compared between VF progressors and non-progressors, using linear mixed effects models. Cox proportional hazards model and linear regression models were used to identify factors associated with VF progression, the VF MD reduction rate and the change rate of mean total deviation in central 12 VF points (MTD10). A total of 131 eyes were included and VF progression was detected in 32 eyes (24.4%) during 3.45 years of follow-up. The rates of reduction in vessel density in the 300 µm width annular region surrounding the FAZ (FD300) and macular ganglion cell-inner plexiform layer thickness (mGCIPLT) were significantly faster in progressors than in non-progressors. The faster VF MD or MTD10 reduction rates were associated with faster rates of FD300 loss and mGCIPLT reduction. The FD300 reduction rate is significantly associated with VF progression in early-stage OAG eyes with CVF defects. FD300 may be an adjunctive biomarker of VF progression in glaucomatous eyes with CVF defects.

Topographic comparison of the retinal microvascular changes between patients with compressive and glaucomatous optic neuropathies.

We investigated the difference in optical coherence tomography angiography characteristics between the patients with compressive optic neuropathy (CON, n = 26) and glaucomatous optic neuropathy (GON, n = 26), who were matched for the severity of visual field defect. The peripapillary retinal nerve fiber layer (pRNFL) thickness in the nasal and temporal sectors was thinner in the CON group, whereas the inferior pRNFL thickness was thinner in the GON group. Accordingly, the CON group had lower peripapillary vessel density (pVD) in the nasal and temporal sectors, and the GON group in the inferior sector. In the macular area, the CON group had a thinner macular ganglion cell-inner plexiform layer in the superior and nasal sectors, whereas the GON group in the inferior sector. However, the CON group did not have a lower macular VD than the GON group in any sector, whereas the GON group exhibited lower superficial capillary plexus VD in the superior, inferior, and temporal sectors. Comparison of the structure-vasculature correlation revealed a significant difference in the nasal and temporal peripapillary areas and superior and nasal macular sectors; a decrease in VD was greater in the GON group than in the CON group when the comparable structural change occurred.

Morning Blood Pressure Surge and Glaucomatous Visual Field Progression in Normal-Tension Glaucoma Patients With Systemic Hypertension.

PURPOSE: To investigate the impact of a morning blood pressure surge (MBPS) at baseline on subsequent visual field (VF) progression in hypertensive, normal-tension glaucoma (NTG) patients receiving oral anti-hypertensive treatment. DESIGN: Retrospective cohort study. METHODS: A total of 127 eyes from 127 newly diagnosed NTG patients treated for systemic hypertension and followed up for at least 2 years were analyzed. All patients underwent baseline 24-hour ambulatory blood pressure monitoring (ABPM) and at least 5 serial VF examinations during the follow-up period. VF progression was defined according to the Early Manifest Glaucoma Trial criteria. The associations of VF progression with 24-hour ABPM-based blood pressure (BP) parameters (including MBPS) and other clinical variables were analyzed using Cox regression analyses. Kaplan-Meier survival analysis was used to compare VF survival estimates in patients with and without MBPS. RESULTS: VF progression was detected in 38 eyes (29.9%) over a 5.2-year mean follow-up. In the multivariate Cox regression model, a greater MBPS (hazard ratio [HR] = 1.033; P = .024) and lower nighttime mean arterial pressure (MAP) trough (HR = 0.965; P = .031) at baseline were significant independent predictors of subsequent VF progression. The likelihood of VF progression was significantly greater in patients with higher MBPS (P = .021) at baseline according to Kaplan-Meier survival analysis. CONCLUSIONS: An increased MBPS at baseline is a significant independent predictor of subsequent VF progression in NTG patients with systemic hypertension. This may be another relevant BP parameter associated with VF progression in hypertensive NTG patients receiving oral anti-hypertensive treatment.

Detection of macular and circumpapillary structural loss in normal hemifield areas of glaucomatous eyes with localized visual field defects using spectral-domain optical coherence tomography.

BACKGROUND: To investigate thickness of the macular ganglion cell complex (mGCC) and circumpapillary retinal nerve fiber layer (cRNFL) in retinal segments without visual field (VF) loss in glaucomatous eyes in which localized VF defects were confined to a single hemifield, using spectral-domain optical coherence tomography (SD-OCT). METHODS: Seventy-one Asian glaucomatous patients and 64 normal subjects underwent mGCC and cRNFL imaging employing RTVue-100 SD-OCT. We compared both thickness parameters in retinal segments without VF defects with those in segments in which such defects were evident, and in matched segments of normal controls. Linear regression analysis was used to investigate the relationship between mGCC and cRNFL thickness parameters of segments with or without VF defects, and glaucoma status based on Humphrey field analyzer (HFA) indices. RESULTS: Mean mGCC thickness in the hemiretinae of glaucomatous eyes without VF defects was 87.2 ± 9.3 µm, significantly lower than in matched control hemiretinae (96.2 ± 5.0 µm; p < 0.001), but significantly higher than in glaucomatous hemiretinae with VF defects (76.4 ± 9.9 µm; p < 0.001). A similar trend was also noted with mean cRNFL thickness. There were significant associations between both thickness parameters in glaucomatous hemiretinae with or without VF loss and degree of VF damage at initial presentation. CONCLUSIONS: Perimetrically normal hemifields of glaucomatous eyes had significantly lower mGCC and cRNFL thicknesses than did the corresponding retinal regions of healthy eyes. SD-OCT may be a useful ancillary diagnostic tool for evaluation of early macular and circumpapillary structural changes in glaucomatous eyes with localized VF defects.

Efficacy, Safety and Patient-Reported Outcomes with Preservative-Free (PF) Tafluprost or PF-Dorzolamide/Timolol Compared with Preserved Latanoprost: A Prospective Multicenter Study in Korean Glaucoma Patients with Ocular Surface Disease.

To compare the efficacy, patient-reported satisfaction, and safety of preservative-free (PF)-tafluprost, PF-dorzolamide/timolol and preservative-containing (P)-latanoprost in Korean glaucoma patients with ocular surface disease (OSD). In a multicenter, prospective, interventional, non-randomized, controlled 12-week trial, 107 eligible patients received PF-tafluprost (n = 37), PF-dorzolamide/timolol (n = 34), or P-latanoprost eye drops (n = 36). Outcomes included changes from baseline in OSD Index (OSDI) scores (primary endpoint), intraocular pressure (IOP), and patient-reported treatment satisfaction, and safety at 12 weeks. At 12 weeks, the mean total OSDI and subdomain (dry eye symptoms, visual-related function, environmental triggers) scores significantly improved from baseline with PF-tafluprost and PF-dorzolamide/timolol, but not with P-latanoprost. Significantly more PF-tafluprost than P-latanoprost recipients reported 'highly improved/improved' satisfaction (no significant difference between PF-dorzolamide/timolol and P-latanoprost). IOP changes were comparable among all three treatment groups. No new safety concerns were observed. PF-tafluprost and PF-dorzolamide/timolol showed statistically and clinically significant reductions in OSDI compared with P-latanoprost in Korean glaucoma patients with OSD.