This article is more than 5 years old. Information may no longer be current.
Progression seen over long term in nearly half of patients with low-pressure glaucoma
Click Here to Manage Email Alerts
Glaucoma progressed after more than 8 years despite treatment in almost half of patients with low-pressure glaucoma, a study found.
The retrospective study, conducted at the Wills Eye Hospital Glaucoma Research Center, included 49 eyes of 49 patients who were followed for low-pressure glaucoma for at least 8 years. Mean follow-up was 9.3 years.
Progression was defined as worsening of both disc and visual field status.
Glaucoma progressed in 25 eyes and was stable in 24 eyes. Median patient age at diagnosis was 58 years in the group that progressed and 63 years in the stable group.
Glaucoma tended to progress in patients with thinner central corneal thickness and disc hemorrhage.
Estimated change in median deviation in visual field status each year was –0.57 dB in the progression group and –0.10 dB in the stable group (P < .0001).
Peak IOP was 17.6 mm Hg in the progression group and 15.8 mm Hg in the stable group; the between-group difference was statistically significant (P = .043).
IOP change after pupil dilation, final IOP and change in IOP from baseline were similar between the two groups.
Additionally, 48% of patients who progressed and 16.7% of patients who were stable required surgery and laser treatment; the between-group difference was not statistically significant. – by Matt Hasson
Disclosure: The authors report no relevant financial disclosures.
Perspective
Back to Top
Derek MacDonald, OD, FAAO
Whether normal-tension glaucoma represents a distinct entity or part of a disease continuum, glaucoma in the presence of statistically normal IOP remains a common clinical presentation. Erdem and colleagues’ retrospective review adds valuable insight to inform our management.
Lowering and stabilizing IOP are both important: Despite equal and relatively low IOP at baseline (about 13 mm Hg), nearly 50% of patients progressed, with a peak IOP nearly 2 mm Hg higher than those remaining stable. Although the role of IOP fluctuation remains controversial, variability at low pressures may be particularly important.
Do not be fooled by age or IOP: The authors note three young patients (aged 25, 39 and 50) in whom five of six eyes had advanced structural and functional damage at presentation, emphasizing the importance of a vigilant clinical exam for each and every patient, regardless of age or IOP.
Trend analysis may mandate aggressive IOP lowering: Particularly in young patients with advanced or rapidly progressing disease, a very low target IOP, perhaps only attainable through incisional surgery, may be necessary to avoid visually significant disability within their lifetime.
Our care of patients with NTG must continue while semantic arguments are resolved; this long-term analysis assists us in doing exactly that.
Collapse
Erdem E, at al. Eur J Ophthalmol. 2015;doi:10.5301/ejo.5000624.
Click Here to Manage Email Alerts