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Investigators identify new vascular factors predictive of glaucoma progression

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Low ocular systolic perfusion pressure, low systolic blood pressure and a history of cardiovascular disease may be new factors predicting the progression of open-angle glaucoma, suggesting a vascular role in disease progression, according to results from the Early Manifest Glaucoma Trial.

M. Cristina Leske, MD, MPH, and colleagues investigated factors associated with glaucoma progression among 255 patients with early open-angle glaucoma. All patients were enrolled in the Early Manifest Glaucoma Trial, which randomly assigned 129 patients to receive argon laser trabeculoplasty and betaxolol and 126 patients to receive no immediate treatment, according to the study.

All patients were examined every 3 months for up to 11 years, with a median follow-up of 8 years.

Overall, glaucoma progressed in 67% of patients by the end of follow-up. Patients who received ALT had approximately half the risk of progression, and the risk of progression was similar for these patients regardless of baseline IOP, the authors reported.

Investigators found that baseline symptoms predictive of progression included higher IOP, exfoliation, bilaterality and older age (P < .01), which confirms findings from previous reports.

In addition, disc hemorrhages observed during follow-up predicted progression, also confirming previous reports, they noted.

However, new baseline factors predictive of progression included ocular systolic perfusion pressure of 160 mm Hg or less in all patients, a history of cardiovascular disease in patients with higher baseline IOPs and systolic blood pressure of 125 mm Hg or less in patients with lower baseline IOPs, according to the study.

Also, a new factor predicting progression was thinner central corneal thickness, although this was only observed among patients with higher baseline IOPs.

At all follow-up points, IOP remained a risk factor of progression, "with 12% to 13% average increase per millimeter of mercury in all patients ... and similar results in patients with higher and lower baseline IOP," the authors said.

The study is published in the November issue of Ophthalmology.