May 2007
Volume 48, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2007
Intraocular Pressure Control as a Contributing Factor to Long-Term Visual Field Loss in the Collaborative Initial Glaucoma Treatment Study
Author Affiliations & Notes
  • D. C. Musch
    University of Michigan, Ann Arbor, Michigan
    Ophthalmology & Visual Sciences, and Epidemiology,
  • B. W. Gillespie
    University of Michigan, Ann Arbor, Michigan
    Biostatistics,
  • P. R. Lichter
    University of Michigan, Ann Arbor, Michigan
    Ophthalmology & Visual Sciences,
  • L. M. Niziol
    University of Michigan, Ann Arbor, Michigan
    Ophthalmology & Visual Sciences,
  • Footnotes
    Commercial Relationships D.C. Musch, Allergan, Inc., F; Glaukos Corporation, C; B.W. Gillespie, None; P.R. Lichter, None; L.M. Niziol, None.
  • Footnotes
    Support NIH Grant EY015860; Allergan, Inc.
Investigative Ophthalmology & Visual Science May 2007, Vol.48, 847. doi:
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      D. C. Musch, B. W. Gillespie, P. R. Lichter, L. M. Niziol; Intraocular Pressure Control as a Contributing Factor to Long-Term Visual Field Loss in the Collaborative Initial Glaucoma Treatment Study. Invest. Ophthalmol. Vis. Sci. 2007;48(13):847.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose:: To evaluate the impact of various measures of intraocular pressure (IOP) control on progression of visual field (VF) loss during long-term treatment for newly diagnosed, open-angle glaucoma (OAG).

Methods:: 607 patients with newly-diagnosed OAG were randomly assigned to initial treatment with medications or with trabeculectomy. These patients underwent examination at six-month intervals by standardized testing, including Goldmann applanation tonometry and Humphrey 24-2 full threshold VF tests. Repeated measures analyses were conducted using SAS Proc Mixed and Genmod to develop predictive models for VF outcomes based on the mean deviation (MD) from VF testing. Analyses included follow-up data extending through nine years post-randomization. Statistical modeling of VF loss over time adjusted for age, sex, race, baseline VF loss, treatment, and time. IOP was included as a time dependent variable, and its association with VF loss was assessed in the period from 3 to 9 years post-randomization.

Results:: Measures of IOP control included the maximum IOP, mean IOP, standard deviation of IOP, proportion of IOP measurements under 16, 18, 20, or 22 mmHg, and whether all IOP values were under the these four cut-points. Two measures of IOP control - the maximum IOP value and standard deviation of IOP - were significantly associated both with the mean VF (p<0.0001) and the frequency of substantial VF loss in the 3 to 9 year period (p≤0.002). For example, a 1 mmHg increase in the maximum IOP is associated with a 7% increase in the predicted odds of a 3 or more decibel worsening of the mean deviation from VF testing. Likewise, a 1 mmHg increase in the standard deviation of IOP is associated with a 24% increase in the predicted odds of a 3 or more decibel worsening of the mean deviation.

Conclusions:: Occurrences of high IOP and evidence of more variation in IOP measures are strongly predictive of progressive VF loss over an extended period of treatment. These results support regular monitoring of IOP in patients under treatment, and considering more aggressive treatment when undue elevation or variation in IOP measures are observed. Review of the patient’s IOP record over an extended time is an important component of evaluating a patient’s glaucoma treatment.

Clinical Trial:: www.clinicaltrials.gov NCT00000149

Keywords: intraocular pressure • visual fields • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials 
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