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Jibran Mohamed-Noriega, Hari Jayaram, Brigid Ning, Deborah Kamal, Nicholas Strouthidis, David F Garway-Heath; Does intraocular pressure reduction prevent visual field progression in patients with disc haemorrhages?. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3916.
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© ARVO (1962-2015); The Authors (2016-present)
Disc haemorrhage (DH) is an important predictive factor for visual field (VF) progression. However, previous clinical trials have not shown a reduction of VF progression after lowering intraocular pressure (IOP) in patients with DH. We investigated the effect of lowering IOP, medically and surgically, in the United Kingdom Glaucoma Treatment Study (UKGTS) and a cohort of normal tension glaucoma (NTG) patients that underwent trabeculectomy, respectively.
In the UKGTS, newly diagnosed glaucoma participants were randomised to placebo (258) or latanoprost (258). Fundus photography (FP) and HRT3 images were acquired over 11 visits (24 months). In the NTG cohort, 97 consecutive patients (130 eyes) underwent trabeculectomy with Mitomycin-C between May 2007 and September 2013 at Moorfields Eye Hospital. Clinical notes, HRT3 images, and 24-2 VF were reviewed retrospectively as part of a clinical audit. DHs were identified per visit and eye by an ophthalmologist masked to treatment allocation and VF outcome. For the UKGTS, the full series of FP and HRT3 images were analysed with a baseline/follow-up flicker method. For the NTG cohort, HRT3 images and the notes of all visits to the glaucoma clinic were used to identify DHs. For all participants, VF progression was based on the Humphrey Field Analyzer GPA reports.
Among the UKGTS participants, 121 (26.2%) had a DH in either eye at any visit (DH+). Among the 121 DH+ participants, 12 (20.3%) and 24 (38.7%) progressed in the latanoprost and placebo group respectively (p=0.027). Among the 395 DH- participants, 25 (12.6%) and 37 (18.9%) progressed in the latanoprost and placebo group, respectively (p=0.085). The relative risk reduction of latanoprost in the DH- and DH+ group was 33.3% and 47.5%. In the placebo and latanoprost group, 8.3% and 8.4% of all visits had a DH (p=0.975). In the NTG cohort, 109 (83.8%) eyes were included for the VF progression analysis and 31 (28.4%) had a DH before trabeculectomy. VF progression after surgery was identified in 14 (17.9%) DH- and 2 (6.5%) DH+ eyes (p= 0.126). 3.5% of pre- and 0.9% post-trabeculectomy visits had a DH (p<0.001).
Medical reduction of IOP significantly reduces VF progression in DH+ eyes, but does not influence the incidence of DHs. Surgical reduction lowers the incidence of further DHs; a smaller proportion of DH+ eyes progressed after surgery compared to DH- eyes.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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