Natural History and Risk Factors for Glaucoma Progression in Chinese Patients With Normal-Tension Glaucoma.

Purpose: To characterize the natural history of normal-tension glaucoma (NTG) in Chinese patients. Methods: The prospective observational cohort study included patients with untreated NTG with a minimum follow-up of 2 years. Functional progression was defined by visual field (VF) deterioration, while structural progression was characterized by thinning of the retinal nerve fiber layer (RNFL) or ganglion cell inner plexiform layer (GCIPL). Results: Among 84 participants (mean age, 60.5 years; mean deviation, -5.01 decibels [dB]) with newly diagnosed NTG followed for an average of 69.7 months, 63.1% progressed during the observation period. Specifically, 29.8% progressed by VF, and 48.8% progressed by either RNFL or GCIPL. In Cox proportional hazards analysis, disc hemorrhage (hazard ratio [HR], 2.82; 95% confidence interval [CI], 1.48-5.35), female gender (HR, 1.98; 95% CI, 1.08-3.62), and mean IOP during the follow-up period (HR, 1.14 per mm Hg; 95% CI, 1.00-1.31) were significant predictors of glaucomatous progression. Additionally, longer axial length (AL; HR, 0.57 per millimeter; 95% CI, 0.35-0.94) was protective against VF progression faster than -0.50 dB/y, and higher minimum diastolic blood pressure (DBP; HR, 0.96 per mm Hg; 95% CI, 0.92-1.00) was protective against structural progression. Conclusions: Nearly two-thirds of untreated Chinese patients with NTG progressed over an average follow-up of 70 months by VF, RNFL, or GCIPL. Disc hemorrhage, female gender, higher mean IOP, shorter AL, and lower minimum DBP were significant predictors for disease progression.

Association of spouse's vision impairment with depressive symptoms and cognitive decline in partner: A nationally representative study in China.

BACKGROUND: Although several previous studies have reported on the relationship between vision impairment and caregiver mental health, mixed results were obtained, and only one study reported the association between spousal vision impairment and partner depression. Therefore, our study aimed to examine the association between spousal vision impairment and the partner's depressive symptoms and cognitive decline. METHODS: This cross-sectional study gathered baseline data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011. A total of 10,956 couples were included in the study. Vision impairment was assessed by respondents' self-reported distance or near vision. Multivariate logistic and linear regression were conducted to evaluate the association between the spouse's vision impairment and the partner's depressive symptoms and cognitive function. RESULTS: The prevalence of partners with depressive symptoms was significantly higher among spouses with vision impairment than among those without (43.3 % vs. 32.5 %; P < 0.001), and cognitive function was significantly lower (spousal vision impairment 14.4 ± 4.5 vs. no spousal vision impairment 15.5 ± 4.6; P < 0.001). After fully adjusting for potential confounders, the partner had greater odds of depressive symptoms for spouses with vision impairment than for those without (odds ratio: 1.525; 95 % confidence interval [CI]: 1.387 to 1.677). Furthermore, spousal vision impairment was negatively associated with the partner's cognitive function (ß = -0.640; 95 % CI: -0.840 to -0.440). Sensitivity analysis was performed, and consistent results were obtained (all P < 0.05). LIMITATIONS: Visual function was assessed by self-reporting. CONCLUSIONS: A spouse's vision impairment is associated with depressive symptoms and cognitive decline in the partner. The findings imply the importance of considering the partner's mental health when managing their spouse's vision impairment.

Progressive peripapillary capillary vessel density loss and long-term visual field progression in Normal tension glaucoma.

PURPOSE: To explore the association between progressive peripapillary capillary vessel density (pcVD) reduction and the progression of visual field (VF) impairment in individuals with normal tension glaucoma (NTG). DESIGN: Prospective cohort study. METHODS: The study enrolled 110 participants with one eye each, totalling 110 NTG eyes. VF defects were evaluated using standard automated perimetry mean deviation (MD), while pcVD measurements were obtained using optical coherence tomography angiography throughout the follow-up period. Estimates of VF progression were determined by event-based and trend-based analyses. Fast VF progression was defined as an MD slope steeper than -0.5 dB/year, while the slow progression or stable VF was defined as an MD slope better or equal to -0.25 dB/year. Linear mixed-effects models were employed to analyse the rates of change in pcVD reduction and VF MD decline over time. Additionally, univariable and multivariable linear models were used to examine the relationship between pcVD changes and VF loss rates in NTG. RESULTS: Slow VF progression or stable VF was observed in 45% of subjects, while 25% had moderate progression and 30% showed fast progression. Patients with VF progression exhibited faster rate of pcVD reduction in peripapillary global region (-0.73 ± 0.40%/year vs. -0.56 ± 0.35%/year, p = 0.022). Moreover, this rate positively correlated with VF MD decline in NTG (estimate 0.278, 95% CI 0.122-0.433, p = 0.001). CONCLUSION: In individuals with NTG, faster VF progression was linked to a quicker reduction in pcVD, suggesting a positive correlation between pcVD decline and VF deterioration.

Population-based associations between progression of normal-tension glaucoma and Yang-deficient constitution among Chinese persons.

PURPOSE: To explore the association between constitution types as defined by traditional Chinese medicine (TCM) and risk for normal-tension glaucoma (NTG). DESIGN: Population-based cohort study. METHODS: Persons were identified in a population cohort aged ≥30 years with NTG, defined as having an untreated mean intraocular pressure measurement ≤21 mm Hg over six separate occasions, with no single reading >24 mm Hg (as in the Collaborative Normal Tension Glaucoma Study). The Body Constitution in Traditional Chinese Medicine Questionnaire was used to assess each participant's TCM constitution types. The association between various constitutions and visual field progression according to Early Manifest Glaucoma Trial criteria was assessed using Cox regression HR models. RESULTS: Among 142 participants (245 eyes), 23 persons (17.6%) and 25 eyes (10.2%) progressed, over a mean (SD) follow-up duration of 3.49 (0.99) years. Progression rates were highest in participants with Yang-deficient constitution (n=19, 13.4%), among whom 7 (36.8%) exhibited worsening fields. After adjusting for sex, age, central corneal thickness, retinal nerve fibre layer thickness and mean deviation on visual field testing, Yang-deficient constitution (HR 4.63, 95% CI 1.77 to 12.1, p=0.002) and higher mean intraocular pressure during follow-up (HR 1.25, 95% CI 1.01 to 1.56, p=0.044) were associated with field progression. CONCLUSIONS: Yang-deficient constitution and higher intraocular pressure are risk factors for visual field progression in NTG patients. Yang deficiency is characterised by abnormal vasoregulation, and these results may be consistent with prior studies linking NTG progression to Raynaud's phenomenon and migraine.

Faster Macular Vessel Density Loss in More Advanced Primary Open Angle Glaucoma Eyes.

PURPOSE: To characterize and compare the longitudinal change of macular vessel density (VD) in primary open angle glaucoma (POAG) eyes across different disease stages. METHODS: This is a sub-analysis of a prospective cohort study. A total of 103 eyes (53 eyes in the mild stage, 50 eyes in the moderate-to-advanced stage) of 75 POAG patients followed for more than 1 year with at least 2 qualified optical coherence tomography (OCT) angiography (OCTA) images were included. The rates of macular VD change were determined by linear regression and compared using the generalized linear mixed models between groups. Mixed effect models were used to evaluate the demographic and ocular parameters associated with the VD loss rate. RESULTS: With a mean follow-up time of 2.36 years, the rates of macular VD change were significantly different from zero in both groups. The rates of macular VD loss were significantly faster in moderate-to-advanced stage group than in mild stage group in whole image (-2.46%/yr vs -1.47%/yr, p=0.002), superior hemifield (-2.42%/yr vs -1.30%/yr, p=0.001), para fovea (-2.35%/yr vs -1.26, p=0.001), superior (-2.20%/yr vs -1.01%/yr, p=0.002), nasal (-2.41%/yr vs -1.04%/yr p=0.001), inferior (-2.46%/yr vs -1.43%/yr, p=0.018) and temporal sectors (-2.32%/yr vs -1.58%/yr, p=0.012). Baseline mean deviation (MD) and OCT parameters were associated with the rates of macular VD loss. CONCLUSIONS: OCTA measurements could detect vascular deterioration over time in POAG eyes at different stages. The rates of macular VD loss were significantly faster in more advanced POAG eyes.

Structure-function correlation of localized visual field defects and macular microvascular damage in primary open-angle glaucoma.

PURPOSE: To investigate regional alterations of macular microvasculature in primary open-angle glaucoma (POAG), and to determine the structure-function correlation between localized visual field defects and macular microvascular damage in matching sectors. METHODS: Fifty-eight patients with POAG and 27 normal controls were recruited for this study. Optical coherence tomography angiography (OCTA) was used to measure retinal vascular microcirculation of the macula in superior, inferior, temporal, and nasal sectors. Visual field (VF) was tested using automated perimeter. Sensitivities of 16 central points of the VF were selected and divided into the 4 previously mentioned sectors. Structure-function correlation analysis was performed between localized visual field defects and the matching macular microvasculature damage. The relationship was also assessed using a previously described model. RESULTS: The temporal vascular density was thinner than those of the superior and inferior positions of parafovea in the control group (P < 0.05). Vascular densities in all sectors were decreased in the POAG group compared with the normal control group (P < 0.05). The structure-function correlation coefficients between sectors of VF sensitivity and the matched vascular densities ranged from 0.295 to 0.433 (P < 0.01). The coefficient of determination between OCT derived vascular density measurements and the estimates using the previous model ranged from 0.08 to 0.19. The best fit was in the inferior sector. CONCLUSIONS: Compared with age-matched control subjects, vascular density of the parafoveal retina decreased in the POAG subjects. There is a moderate structure-function correlation between visual field sensitivity thresholds measured with automated perimeter and macular vascular density assessed by OCT.