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V. V. Juthani, C. G. de Moraes, C. A. Liebmann, C. C. Teng, C. Tello, R. Ritch, J. M. Liebmann; IOP Parameters and Visual Field Progression in Patients With Treated Glaucoma. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3496.
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© ARVO (1962-2015); The Authors (2016-present)
To determine which IOP parameter correlates most highly with visual field (VF) progression in treated glaucoma patients.
The charts of all patients seen in a glaucoma referral practice between 1999 and 2009 were reviewed. Only eyes with >8 SITA Standard 24-2 VF tests with baseline glaucomatous VF damage were included. Mean follow-up IOP (mmHg), peak IOP, IOP fluctuation (standard deviation), age, CCT, and baseline mean deviation (MD) for each patient were recorded. Automated pointwise linear regression analysis determined global and localized rates (dB/yr) of change. Progression was defined when 2 or more adjacent test locations in the same hemifield showed a threshold sensitivity decline at a rate of >1.0 dB/year with p<0.01.
587 eyes (587 patients; mean age, 64.9±13.0 yrs; mean number of VF tests, 11.1±3.0; mean follow-up, 6.4±1.7 yrs) were included. 169 (28.8%) eyes progressed. Progressing eyes had thinner corneas (533±38 vs. 544±36 µm, p=0.001), higher mean IOP (15.9±2.82 vs. 14.9±3.2, p<0.001), higher peak IOP (21.4±4.5 vs. 19.3±4.4, p<0.001), and greater IOP fluctuation (3.0±1.6 vs. 2.4±1.3, p<0.001) than non-progressing eyes. Global rates of change of progressing eyes were faster than non-progressing eyes (-1.1±0.89 vs. -0.2±0.5 dB/yr, p<0.001). There was moderate to strong correlation among all IOP parameters (all p<0.01). Peak IOP showed the best association with VF progression (AUROC for Peak IOP, 0.636±0.026; 0.618±0.026 for IOP fluctuation; 0.587±0.026 for mean IOP).
Trend analysis confirms the important roles of age, CCT, and IOP on VF progression in treated glaucoma. Peak IOP is the most important IOP parameter and should be minimized in these eyes.
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