An evaluation of the effect of unoprostone isopropyl 0.15% on ocular hemodynamics in normal-tension glaucoma patients.

BACKGROUND: Because intraocular pressure-lowering agents should have a good safety profile with regard to ocular hemodynamics, the innocuousness of unoprostone isopropyl 0.15% with regard to ocular hemodynamics in vasospastic patients with normal-tension glaucoma was assessed in a pilot study. METHODS: Corneal temperature as a parameter of ocular blood flow and choroidal and optic nerve blood flow as assessed by means of laser Doppler flowmetry techniques were evaluated in 12 vasospastic normal-tension glaucoma patients in a prospective, randomized, observer-masked, two-period crossover, placebo-controlled pilot trial. RESULTS: Statistical analysis in 2 x 2 two-way analysis of variance models with two treatments (placebo and unoprostone isopropyl) and two assessments (baseline and after 1 week of treatment) as within-subject factors disclosed a lack of difference between eyes, between the treatment (placebo/unoprostone isopropyl) periods, and between baseline and after 1 week of treatment in corneal temperature, choroidal blood flow, and optic nerve blood flow. The differences between the results at baseline and after 1 week of treatment in these parameters were not significantly different between the placebo treatment period and the unoprostone isopropyl treatment period, and this was comparable in fellow eyes for all the parameters. CONCLUSION: Unoprostone isopropyl did not induce any alterations in ocular hemodynamics in this pilot study with vasospastic normal-tension glaucoma patients.

Body mass index in glaucoma.

PURPOSE: To compare body mass index (BMI) of patients with open-angle glaucoma or normal-tension glaucoma with BMI in control subjects. METHODS: BMI was calculated for 288 control subjects, 42 patients with open-angle glaucoma with treated intraocular pressure (IOP) higher than 21 mmHg, 87 patients with open-angle glaucoma with progression of glaucomatous damage despite IOP less than 21 mmHg, and 57 patients with normal-tension glaucoma. RESULTS: There was no statistical difference in BMI between patients with glaucoma and control subjects. If anything, there was a tendency for patients with glaucoma to have a lower BMI than control subjects. CONCLUSION: These data show that obesity seems not to be a risk factor for glaucoma.

Fludrocortisone in the treatment of systemic hypotension in primary open-angle glaucoma patients.

BACKGROUND: Fludrocortisone is a potent mineralocorticoid, which has no known direct vasoactive properties, and is the first-line drug for treatment of orthostatic hypotension. The present study evaluated the systemic hemodynamic effects of fludrocortisone treatment in glaucoma patients. PATIENTS AND METHODS: A retrospective analysis of the charts of glaucoma patients of the University Eye-Clinic Basel was performed. Twenty-two patients with open-angle glaucoma under treatment with fludrocortisone were selected. The selected patients had one 24-h blood pressure recording immediately prior to treatment with fludrocortisone and one recording at least 2 months after starting the treatment. Parallel to blood pressure recordings, diurnal intraocular tension curve recordings and visual field testings were carried out. In addition, twelve patients also had nail-fold video-capillaroscopy. RESULTS: IOP and visual fields remained stable. The average values for all systemic blood-pressure readings showed an improvement in the follow-up compared to primary examination. Mean (+/- SD) night-to-day ratio ('nocturnal dips') of systolic, diastolic and mean arterial blood pressure decreased from 13.6 +/- 4.3%, 16.9 +/- 5.2% and 15.9 +/- 3.5%, respectively, to 9.9 +/- 5.9% (p = 0.01), 13.2 +/- 4.3% (p = 0.044) and 11.7 +/- 3.9% (p = 0.0004). Baseline capillary blood-flow velocity increased and capillary blood-flow standstill time after cold provocation decreased significantly under fludrocortisone therapy. CONCLUSION: Hemodynamic parameters show a tendency towards improvement in a magnitude which might be of clinical relevance.

Blood-flow velocities of the extraocular vessels in patients with high-tension and normal-tension primary open-angle glaucoma.

PURPOSE: To evaluate blood-flow parameters in three different groups of patients with primary open-angle glaucoma. METHODS: Hemodynamic parameters in the ophthalmic artery, central retinal artery, central retinal vein, and lateral and medial short posterior ciliary arteries were evaluated by color Doppler imaging in 237 patients with primary open-angle glaucoma and 124 age-matched normal control subjects. Group A consisted of 56 patients with primary open-angle glaucoma with treated intraocular pressure higher than 20 mm Hg; group B, of 103 patients with primary open-angle glaucoma with progression of glaucomatous damage despite intraocular pressure of 21 mm Hg or less; and group C, of 78 patients with normal-tension glaucoma. RESULTS: All patients showed a significant decrease in end-diastolic velocities (P < .01) and a significant increase in resistivity index (P < .05) in all arteries measured. Peak-systolic velocities were normal in the ophthalmic artery in all three groups. In the central retinal artery and the short posterior ciliary arteries, however, patients in groups B and C had significantly reduced peak-systolic velocity (P < .05) compared with normal control subjects. Peak-systolic velocity in group A did not differ significantly from that of normal control subjects. Maximal and minimal blood-flow velocities in the central retinal vein were significantly lower in groups B and C (P < .001) compared with normal control subjects. In group A, only minimal blood-flow velocity was significantly reduced (P < .05). CONCLUSIONS: Hemodynamic parameters in the extraocular vessels are altered in patients with glaucoma. Reduced blood-flow velocities may be secondary as well as contributory to glaucomatous damage.

Evaluation of the Brusini glaucoma staging system for follow-up in glaucoma.

BACKGROUND: Brusini developed a new interpretation system for Octopus and Humphrey automated perimeters that is based on mean defect (MD) and corrected loss variance (CLV) or corrected pattern standard deviation (CPSD). This study tested the performance of Brusini's glaucoma staging system (GSS) in staging and follow-up. METHODS: Retrospectively, 610 visual fields of 64 eyes of open-angle glaucoma patients were analyzed with Brusini GSS and compared with Aulhorn-Karmeyer stages and by PeriData 7.0 trend analysis. RESULTS: Follow-up was comparable to PeriData 7.0 trend analysis in 97%. Change was observed in 41% of eyes, i.e., initial improvement (19% eyes), deterioration (16%), and after an initial improvement, either deterioration (11%) or a stable period (5%). No change was seen in 59% of the eyes, of which 30% showed small and 19% high long-term fluctuation (LF) due to fatigue effect, poor cooperation of patient, impaired reliability, or short-term fluctuation (SF) greater than 1.7 dB. However, for 8% of the eyes there was no apparent reason for high LF. CONCLUSIONS: Brusini GSS is useful for staging and recommended for follow-up evaluation of visual fields in glaucoma.

Short-term effect of dipyridamole on blood flow velocities in the extraocular vessels.

Dipyridamole is known to inhibit platelet aggregation and to induce vasodilatation. It has been shown that dipyridamole increases blood flow in various tissues in humans as well as in the eyes of animals. We studied the influence of dipyridamole in a prospective open trial in 23 patients with impaired ocular circulation due to different causes, based on experienced clinical judgement, such as anterior ischemic optic neuropathy, vasospastic syndrome, glaucoma, or central retinal vein occlusion. Blood flow velocities in the ophthalmic artery, central retinal artery and vein, one lateral and one medical posterior ciliary artery were measured using a Siemens Quantum 2000 color Doppler device. Blood flow velocities were measured before and under treatment. Dipyridamole increased blood flow velocities significantly in all vessels measured. Therefore, it seems promising to evaluate the effect of dipyridamole over a longer period in patients with impaired ocular blood flow.

Visaline in the treatment of age-related macular degeneration: a pilot study.

Age-related macular degeneration (AMD) is the main cause of a reduction in visual acuity in patients over the age of 65 years. A positive influence of medical treatment (i.e. with vitamins and trace minerals) has been suggested but remains unproven. In this randomized, double-blind study, 20 patients in an early stage of AMD were included. Over a period of 6 months, 9 patients were treated with Visaline and 11 with a placebo. The effect of the treatment was not statistically different between the two groups, admittedly small in number, in terms of visual and retinal acuity, color vision, and contrast sensitivity. Despite the lack of such measureable differences, the patients' own subjective assessments, however, were much better in the Visaline-treated group. Due to the short duration of the observation time, we can not comment on a possible long-term effect.

Intraocular pressure decrease after local ocular cooling is underestimated by applanation tonometry.

BACKGROUND: The effects of intense systemic or local cooling on aqueous humor dynamics in animals are an increased total outflow facility and a decreased aqueous flow. Few studies suggest that only vasoconstriction of arteriolar segments of the episcleral vasculature may be the cause for a decrease in intraocular pressure after local cooling in humans. Because corneal changes may have influenced such studies, the effect of local cooling was assessed in normal subjects. METHODS: Intraocular pressure and corneal thickness were measured in 18 healthy human subjects before and after exposure of the right eye to both, an air stream at 20 degrees C, and an air stream at 0 degrees C. RESULTS: No significant changes in IOP or corneal thickness occurred under 20 degrees C conditions. After local cooling, the mean corneal thickness increased from 0.52 +/- 0.01 mm to 0.57 +/- 0.02 mm (p < 0.001). Mean intraocular pressure decreased from 13.8 +/- 2.9 mmHg to 12.9 +/- 3.1 mmHg (p < 0.026). The observed decrease in IOP correlated significantly but negatively (R = -0.53; p = 0.024) with the increase in corneal thickness, indicating that the cooling effect on IOP may be rather underestimated. CONCLUSION: The eye is very sensitive to local cooling effects, which may, however, partially be masked by changes in corneal thickness.

Influence of posture on the visual field in glaucoma patients and controls.

The intra-ocular pressure rises when body position is changed from sitting to supine. This phenomenon occurs to the same extent in healthy people and glaucoma patients. The purpose of this preliminary study was to determine the effect of posture on the visual field. Visual fields of 15 eyes of 12 normal-tension glaucoma (NTG) patients, 16 eyes of 11 high-tension glaucoma (HTG) patients and 30 eyes of 26 healthy controls were measured in the upright and supine positions with program G1X on an Octopus swivel-arm perimeter. The delta mean defect (delta MD), that is MDupright-MDsupine, was calculated for each patient and compared among study groups. Whereas visual fields improved in healthy controls (delta MD = +0.45 dB), glaucoma patients showed a slight deterioration of the visual field after changing position from supine to upright (HTG: delta MD = -0.25 dB, NTG: delta MD = -0.24 dB). The difference between HTG and controls, as well as between NTG and controls, was statistically significant (p < 0.002, Student's t test). These findings indicate that in some glaucoma patients the regulatory mechanisms for blood supply in the optic nerve head are insufficient.

Longterm visual field follow-up of glaucoma patients treated with beta-blockers.

In a prospective, randomized, double-masked study, 44 patients with primary open-angle glaucoma were treated either with 0.5% betaxolol or 0.5% timolol in both eyes twice daily. Twenty-nine patients could be followed up for 48 months. Seventeen of these patients were treated with betaxolol and 12 with timolol. Each examination included visual field measurements with an Octopus automated perimeter 201 (Program G1), intraocular pressure measurement, funduscopy, as well as pulse and arterial blood pressure measurements. Both drugs lowered in the intraocular pressure. This reduction was slightly but not statistically significantly higher in the timolol-treated group. However, the visual fields improved more in the betaxolol group. Patients treated with betaxolol had significantly smaller averaged mean defects (p < 0.05) and higher averaged mean sensitivities (p < 0.05, Wilcoxon rank score text) than did timolol-treated patients at months 3, 6, 12, and 18. Thereafter, the difference between the two groups was not statistically significant in this relatively small sample size. For betaxolol patients the cumulative area-under-the-curve analysis for the worse eye yielded significantly larger mean sensitivities beyond month 12 (exception: month 30; p < 0.05) and significantly smaller mean defects beyond month 6 (p < 0.05).

High-resolution perimetry of the central visual field.

The Octopus Program M1 was designed for the detection/follow-up of central or paracentral visual field defects in patients with neurological disorders or with macular or perimacular diseases. Within the central 25 degrees visual field, 59 test locations provide a resolution of < or = 1.4 degrees. The differential light sensitivity is measured with 'Octopus normal strategy', i.e. a 4/2/1 staircase procedure. The Program M2X has 81 test locations in the central 10 degrees, giving even higher resolution (< or = 0.7 degrees) of the central visual field. Both programs have 2 phases, the second being a re-test. Program M2X's phases are divided into 4 stages and allow interruption anytime.

Systemic blood pressure in glaucoma patients.

Blood pressure was monitored for 24 h in 32 control patients, 38 open-angle glaucoma patients referred because of decompensated IOP despite maximum treatment, 40 patients with open-angle glaucoma referred because of progressive damage despite controlled IOP, and 39 normal-tension glaucoma patients. In the control group a physiological drop in blood pressure during the night was observed. The patients referred with uncontrolled IOP had blood pressure very similar to that of the control group during both day and night. However, the open-angle glaucoma patients with progression despite well-controlled IOP and also the patients with normal-tension glaucoma had markedly, and statistically significantly, lower systolic blood pressure during both day and night. The difference in diastolic blood pressure was smaller. Thus, blood pressure should be considered in diagnosis.

Swivel arm perimeter for visual field testing in different body positions.

To investigate the influence of body position on visual field results, a 'swivel arm perimeter' was built, based on a modified Octopus 1-2-3. Here, the measuring unit was detected from the control unit and mounted on a swivel arm, allowing its movement in all directions. The first results obtained with this device have indicated that its development was worthwhile.

Do beta-blockers cause vasospasm?

The action of beta-blockers on papillary blood flow is quite controversial. Because there is a known relationship between digital and ocular vasospasm, we measured digital blood flow by laser-Doppler methods as a peripheral index of ocular vasospastic disorders. Thus, the effects of cardioselective (betaxolol) and noncardioselective (timolol) beta-blockers on peripheral blood flow in healthy volunteers were evaluated. Neither beta-blocker lowered peripheral blood flow; for betaxolol, there was even a significant increase compared to no medication. No significant differences between betaxolol and timolol were seen.

[Significance of the peripheral visual field for diagnosis of glaucoma]. / Die Bedeutung des peripheren Gesichtsfeldes für die Glaukomdiagnostik.

Investigated was the significance of semiquantitative tests of the peripheral visual field in glaucoma. For that purpose 793 visual fields of 793 glaucoma patients or glaucoma suspects and 338 visual fields of 338 normal controls (normal central 26 degrees--area) were analysed. Perimetry was performed with an Octopus 201 with the help of program G1, which tests 14 peripheral test locations. In the majority of the 455 glaucoma patients (pathological findings in the central visual field) the periphery was also disturbed. Much to our surprise however, the 338 glaucoma suspects (having normal central visual fields) showed the same frequency of peripheral visual field disturbance as the normals. This holds true for the total peripheral visual field, as well as for the individual test locations. Therefore it makes sense to limit perimetry in glaucoma patients to the central area, provided that the central area is quantitatively measured with an adequate testgrid.

Influence of betaxolol and timolol on the visual fields of patients with glaucoma.

In a double-masked study, 40 patients with primary open-angle glaucoma were randomly assigned to treatment with betaxolol 0.5% or timolol 0.5% in both eyes twice daily. Visual fields and intraocular pressures were studied. Perimetry was performed with the Octopus G1 program two weeks after a washout period and three, six, 12, and 18 months after initiation of treatment. Both drugs reduced intraocular pressure. The reduction in intraocular pressure in the timolol-treated group was more pronounced than that in the betaxolol-treated group; the difference, however, was not statistically significant. In both treatment groups, the visual fields tended to improve during the first six months of treatment and remained stable or tended to deteriorate thereafter. The treatment effect on the visual field was better in the betaxolol-treated group than it was in the timolol-treated group (P = .041).

[Effect of betaxolol and timolol on visual fields in glaucoma patients]. / Einfluss von Betaxolol und Timolol auf das Gesichtsfeld bei Glaukompatienten.

In a prospective, randomized, double-masked study, primary open-angle glaucoma patients were treated twice daily with either betaxolol 0.5% or timolol 0.5%. Patients received a pretreatment baseline examination following a 2 week washout period; they were then examined after 3 and 6 months of treatment. Each examination included visual field measurements with an Octopus automated perimeter and intraocular pressure measurement. The visual fields of the betaxolol group showed on the average a pronounced tendency toward improvement (MD decrease of 2.05 dB); visual fields in the timolol group showed a slight tendency toward improvement (MD decrease of 1.56 dB). The difference between these 2 trends after 6 months was statistically not significant (p greater than or equal to 0.05, U-test). Both drugs lowered intraocular pressure, there was no significant difference between the two drugs (p greater than or equal to 0.05, U-test).

[The Opacity Lens Meter 701: clinical experiences]. / Opacity Lens Meter 701: Klinische Erfahrungen.

The quantitative influence of cataracts on visual fields was studied in 11 patients before and after cataract extraction with intraocular lens implantation. Lens opacity, measured with the Opacity Lens Meter 701, correlated closely with the visual field changes. Measurement of stray light backscattered from the cataractous lens permits quantitative prediction of the influence of cataract on the visual field.