Abstract
Abstract: :
Purpose: Comparison of Humphrey visual field responses to topical carbonic anhydrase inhibitor (CAI) combination therapy with topical beta–blocker among eyes with pericentral scotomata, with or without age–related macular degeneration (AMD). Methods:Setting: Institutional Design: Case–control Study Population: 48 adults; 24 with advanced normotensive excavatory optic neuropathy (NEON) but no ophthalmoscopic evidence of maculopathy (11m/13f mean age 63.8), and 24 with clinically significant nonexudative nodular, confluent or granular drusen, with or without associated optic neuropathy (9m/15f mean age 73.0 +/–2.6 years). Observational Procedures: Periodic ophthalmic examination and Humphrey 30–2 full–threshold perimetry (HVF). Exclusion Criteria: Non age–related, diabetic or exudative maculopathy, uveitis, IOP >21 mmHg. Confirmatory Outcome Measures: Single eyes were assessed 2, 6, and 12 months preceding combination therapy of CAI with added ocular hypotensive and approximately 2, 6, 12 and 36 months thereafter. Mean threshold of initially lowest pericentral locus and central 5–, 10– and full 30–degree zones at each visit were compared with respective pretreatment baseline values, by paired t–test. Masking: HVF were selected by standardized chronologic criteria, and scored in random order. Results: Significant downward threshold trends in four concentrically delineated perimetric zones were seen among AMD eyes prior to therapy. Significant, sustained multidecibel mean threshold increases occurred in all concentrically delineated perimetric zones in both the AMD and NEON groups. Among NEON eyes, mean 30–degree threshold values remained above baseline at all subsequent testing intervals, but reapproached baseline values by month 30. In contradistinction, AMD eyes continued their upward trends throughout the entire follow–up period. Maximal mean threshold increases for NEON eyes were >14 dB (p<0.0001) for the lowest pericentral locus, >4dB (p<0.0001) for the central five degrees, and >2 dB for the central 10– and full 30–degree fields (p=0.003 and 0.02, respectively). Threshold increases among AMD eyes were >12 dB (p<0.0001) for the lowest pericentral locus, ∼5 dB (p<0.0001) for the central five degrees, and ∼3 dB for both the central 10– and full 30–degree fields (p<0.0001 and p=0.001, respectively). Conclusions: Combination CAI and beta–blocker treatment was associated with significant, sustained improvement of pericentral perimetric function in patients with pericentral scotomata, with or without AMD.
Keywords: visual fields • age–related macular degeneration • pharmacology