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Hae-Young Lopilly Park, Sung-Hwan Park, Chan Kee Park; Central Visual Field Progression in Normal-Tension Glaucoma Patients With Autonomic Dysfunction. Invest. Ophthalmol. Vis. Sci. 2014;55(4):2557-2563. doi: 10.1167/iovs.13-13742.
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To investigate the characteristics of visual field (VF) progression in normal-tension glaucoma (NTG) patients with autonomic dysfunction.
Forty-eight NTG eyes with more than seven VF tests during at least 5 years of follow-up were analyzed retrospectively. All participants were referred to rheumatology, where they were subjected to heart-rate variability assessment. Patients were classified into the lowest and highest heart-rate variability groups according to the SD value of the qualified normal-to-normal intervals of the heart-rate-variability assessment. The VF was divided into central and peripheral regions and further classified into superior and inferior regions. Groups in the lowest and highest heart-rate variability groups were compared in terms of rates of change in the mean thresholds of each designated region by using a linear mixed model. Potential clinical factors associated with central VF progression were also investigated.
The baseline VF showed similar stages of glaucoma damage between the lowest and highest heart-rate variability groups. The mean global rate of VF changes was similar between the two groups. Only the rate of VF changes in the central and superior central regions were significantly different between the lowest heart-rate variability group (−1.16 dB/year in the central region and −1.48 dB/year in the superior central region) and highest heart-rate variability group (−0.52 dB/year in the central region and −0.64 dB/year in the superior central region). Baseline VF pattern SD (β = −1.160, P = 0.008), migraine (β = 1.380, P = 0.040), orthostatic hypotension (β = 1.146, P = 0.023), and lower heart-rate variability (β = −1.516, P = 0.010) were significantly associated with central VF progression.
NTG patients with lower heart-rate variability, which reflects autonomic dysfunction with sympathetic predominance, presented faster rate of central VF progression than patients with higher heart-rate variability. Intraocular pressure–independent risk factors, such as migraine, orthostatic hypotension, and autonomic dysfunction, were related to central VF progression.
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