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Miriam Zalish, Alon Harris, Yochai Z. Shoshani, Brent A. Siesky, Melanie A. Pickett, Ingrida Januleviciene, Yoel Arieli, Yara M. Catoira-Boyle, Drew Davis, Mohammadali M. Shoja; Association of Baseline Retrobulbar Blood Flow, Retinal Nerve Fiber Layer Thickness and Age with Rapid Progression of Visual Field AGIS Score in Patients with Open Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5073.
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To assess the association of retrobulbar blood flow, retinal nerve fiber layer (RNFL) thickness, optic nerve head structural changes and age with the progression of visual field as measured by Advanced Glaucoma Intervention Study (AGIS) score in patients with open angle glaucoma (OAG).
Retrobulbar blood flow was examined in relation to RNFL thickness, optic nerve head structure and visual field parameters after 18 months in 103 patients (age 67.1 +/- 10.6 years, 59 female) with OAG participating in the Indianapolis Glaucoma Progression Study. Color Doppler imaging of ophthalmic (OA), central retinal (CRA) and nasal (NPCA) and temporal (TPCA) short posterior ciliary arteries were examined for peak systolic (PSV) and end-diastolic (EDV) blood flow velocities and calculations of vascular resistance (RI). RNFL thickness and optic nerve head structure was assessed with optical coherence tomography. Humphrey Visual Field using a 24-2 standard automated perimetry algorithm (SITA) was used. The cohort of patients was divided into a group of rapid glaucomatous progression which was defined as an increase in AGIS score of at least 4 units over the time period of 18 months, and to non-rapidly progressing patients. Mann-Whitney non-parametric test was used to evaluate the differences between the groups in terms of baseline AGIS score, baseline retrobulbar blood flow, and baseline OCT structural parameters.
12 (11.7%) out of 103 patients with OAG had a rapid glaucomatous progression. Mann-Whitney U non-parametric test revealed that patients with a rapid progression were older (median 75.5 vs 67.0, P=0.002) and had a higher initial AGIS score (median 4.00 vs 0.00, P=0.002) compared to other patients. Baseline CRA PSV and OA EDV tended to be lower in rapidly progressive patients (Median 7.80 vs 8.80, P=0.054; median 5.05 vs 5.08, P=0.099, respectively). Moreover, rapidly progressive patients had thinner RNFL, especially at the superior sector (median 69.00 vs 87.00, P=0.004), and had higher baseline cup/disc horizontal ratios (median 0.84 vs 0.72, P=0.031, respectively).
Age, baseline retrobulbar flow and baseline RNFL thickness may be predictors for faster visual field progression in patients with OAG.
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