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Patients with high tension glaucoma progressed faster than primary angle closure
Rates of visual field progression were found to be faster in patients with high tension glaucoma than in those with primary angle closure glaucoma, at similar baseline severity.
Patient compliance and follow-up are essential determinates for glaucoma treatment outcome in regular clinical care, according to a study recently published in Investigative Ophthalmology & Visual Science.
The authors stated that while clinical trials typically monitor IOP control, compliance and follow-up, progression rates obtained this way may not reflect those of patients receiving regular clinic care.
Researchers conducted this retrospective study using the data of patients with a clinical diagnosis of high tension glaucoma (HTG, n = 310), primary angle closure glaucoma (PACG, n = 304) and normal tension glaucoma (NTG, n = 165) with five or more visual field exams between January 2000 and December 2012.
Matching visual fields for a baseline measurement for progression, researchers compared each glaucoma subtype as well as the age of the individual. They also measured scotoma expansion and scotoma deepening within the three visual field zones: superior arcuate, inferior arcuate and central.
Researchers found that more HTG eyes presented with significant visual field progression compared with the PACG eyes. However, the difference between the number of progressing eyes with HTG and NTG was not statistically significant, and neither was the difference between NTG and PCAG.
According to the study results, when the individual baseline visual fields were matched by age, disease progression was similar across all of the subtypes.
The scotoma deepening (SD) and expansion (SE) in the superior arcuate zone was greater in the HTG and NTG eyes. PACG eyes presented with greater SD and SE in the inferior arcuate zone than the other subtypes.
Researchers concluded that patients with HTG receiving clinical care from glaucoma specialists presented with a faster visual field progression than those with PACG or NTG subtypes. – by Scott Buzby
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Much to our patients’ dismay, visual field testing and glaucoma go hand and hand ... just like Mickey and Minnie, milk and cookies, the 4th of July and fireworks …
Are there similar pairings of visual field defect patterns by type of glaucoma? We typically correlate NTG with visual field defects closer to fixation. HTG is more likely to produce arcuate defects, and PACG often results in diffuse visual field loss.
Adding a new combination to the mix, Ganeshrao and colleagues were able to show in this retrospective study that different patterns of progression present with different types of glaucoma; HTG and NTG showed scotoma enlargement and deepening in superior arcuate areas while primary angle closure glaucoma PACG showed these changes in inferior arcuate locations. Interestingly, rates of visual field progression were found to be more rapid in patients with HTG than in those with PACG.
We all have associations that we make, and these visual field-related correlations can help us identify which glaucoma patients may need more aggressive therapy to deter progression.