Early treatment may still be needed for eyes with stable myopic normal-tension glaucoma
Key takeaways:
- Overall, 22.5% of patients with myopic normal-tension glaucoma showed progression requiring treatment.
- Those with a family history of glaucoma or higher IOP were at an especially increased risk for progression.
Korean adults with stable myopic normal-tension glaucoma who had not received IOP-lowering treatment for at least 1 year were at increased risk for progression, according to a study published in Journal of Glaucoma.
“Lowering of IOP is currently the only practical way to slow the progressive optic nerve damage in normal-tension glaucoma and is initiated in almost all patients with normal-tension glaucoma at diagnosis,” Dong Kyun Han, MD, of the department of ophthalmology at Seoul National University College of Medicine and Seoul National University Bundang Hospital in Seongnam, Republic of Korea, and colleagues wrote.
“As the notion that myopia is less likely to be associated with glaucoma progression gains acceptance, there is a risk that some normal-tension glaucoma eyes may be undertreated due to their myopic condition,” they added. “However, the evidence is not definitive regarding whether IOP-lowering treatment is essential or can be postponed in these patients.”
To assess the impact of IOP and IOP-lowering treatment on myopic normal-tension glaucoma progression, Han and colleagues retrospectively reviewed the medical records of 111 Korean patients with myopic normal-tension glaucoma aged older than 18 years (mean age, 53.6 ± 12.7 years; 42.3% women) from the Seoul National University Bundang Hospital Glaucoma Clinic who had stable disease and had not received IOP-lowering treatment for at least 1 year.
Researchers measured retinal nerve fiber layer (RNFL) thickness and performed a visual field test every 6 to 12 months for more than 2 years.
Patients who showed progression in either OCT or visual field measurements during the 48.7 ± 26-month follow-up period were classified as the P(+) group (n = 25), whereas those who did not show progression were classified as the P(–) group (n = 86).
The researchers used Cox proportional hazards regression to identify risk factors for glaucoma progression and linear regression to determine factors associated with the rate of RNFL thinning.
Multivariable analyses revealed that a family history of glaucoma (P = .023), higher mean IOP (P = .004) and higher maximum IOP (P = .026) were significant risk factors for glaucoma progression and faster RNFL thinning.
The researchers observed that there were no mean IOP values less than 11 mm Hg in the P(+) group.
Additionally, results of the Davies test showed that 14.2 mm Hg was a significant breakpoint (P = .042); among eyes with a mean IOP above this breakpoint, the rate of RNFL thinning increased significantly with the mean IOP (P = .034), according to the researchers.
Han and colleagues acknowledged several limitations to the study, including its retrospective design, small sample size and the generalizability of the findings to other populations.
“Myopia as a risk factor of glaucoma should be interpreted cautiously, taking into account the varied risk profiles of individual myopic patients,” the researchers wrote. “Earlier initiation of treatment should be considered in myopic normal-tension glaucoma eyes at a higher risk of progression, even when the disease seems to be stable.”
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Han DK, et al. J Glaucoma. 2025;doi:10.1097/IJG.0000000000002528.