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C. Tello, W. Shihadeh, T. Grippo, M. Schargus, E. Gramer, J. Liebmann, R. Ritch; Optic Nerve Head Drusen and Visual Field Loss in Normotensive and Hypertensive Eyes . Invest. Ophthalmol. Vis. Sci. 2005;46(13):658.
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Purpose: To compare visual field loss (VFL) in eyes with optic nerve head drusen (ONHD) with or without ocular hypertension (OHT). Methods: The records of all patients with a diagnosis of ONHD at two centers were reviewed. Eyes with OHT (intraocular pressure (IOP) ≥ 22 mmHg) and age–matched normotensive (IOP <22 mmHg) controls were included. All ONHD were visible during clinical or imaging evaluation. All patients underwent achromatic perimetry and had no other ocular disease. VFL was staged according to the Aulhorn visual field classification. The visibility of ONHD was categorized into three grades: 1) no visible ONHD (diagnosed by B–scan and / or OCT), 2) < 7 visible drusen, 3) ≥ 7 visible drusen or presence of plaques. The two groups were compared. Results: 75 eyes of 46 patients (21 males, 25 females) with ONHD were enrolled. Twenty five eyes (15 patients) were hypertensive and 50 eyes (31 patients) were normotensive. Mean age in the hypertensive group was 62.6 +/– 11.7 years and 60.4 +/– 8.8 years in the normotensive group (p= 0.13, T–test). All patients were Caucasian. The mean recorded maximum IOP was 26.5 +/– 5.1 mmHg in the hypertensive group and 16.1 +/– 2.1 mmHg in the normotensive group (p<0.0001). There was no statistically significant difference in the visibility of optic nerve head drusen in the two groups (p=0.43). Visual field loss was greater in hypertensive eyes than in normotensive eyes (p=0.02). Conclusions: Eyes with ONHD and elevated IOP experience more visual field loss than those with normal IOP. Patients with elevated IOP and ONHD should undergo close surveillance for disease progression and be treated appropriately to prevent additional visual field loss.
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