Structural and Functional Progression of Glaucomatous Damage to the Macula with Comorbid Systemic Hypertension

Abstract

Purpose : Hypertension (HTN) is a risk factor that may affect glaucoma progression. There is a weak positive correlation between blood pressure (BP) and IOP, and lower ocular perfusion is associated with glaucoma prevalence and progression. Macular damage was once thought to be significant only in late stages of glaucoma, but recent studies have shown it can occur earlier. This study examines glaucomatous structural progression of the global retina nerve fiber layer (RNFL) and the macula ganglion cell layer (GCL+) with optical coherence tomography (OCT) and functional progression with visual fields (VF) and their relationship with hypertension.

Methods : 191 eyes of 119 patients enrolled in a prospective, longitudinal study (Structural and Functional Progression of Glaucomatous Damage to the Macula study) were analyzed. These patients were tested with 10-2 and 24-2 VF and spectral-domain OCT obtained at 4-6 month intervals. 72 eyes (37%) had self-reported diagnosis of HTN. Linear mixed effects regression was used to test the relationship between summary statistics from VF and OCT and HTN diagnosis. The goodness-of-fit of relationships was assessed with Bayesian Information Criterion.

Results : The average (95% CI) 24-2 and 10-2 MD rate of progression was -0.31 dB/year (-0.43 to -0.19) and -0.36 dB/year (-0.48 to -0.24), respectively. The rate of progression for OCT was -1.14 microns/year (-1.53 to -0.75) for global RNFL and -0.89 microns/year (-1.30 to -0.48) for global macula GCL+. There was no significant difference in rate of progression between HTN and non-HTN patients with any OCT or VF parameter. Yet, models with better goodness-of-fit when testing the relationship between HTN and progression had the following OCT parameters: global macula GCL+, inferior macula GCL+, mean GCL+ of macular vulnerability zone (MVZ), and mean macula GCL+ of less vulnerability zone (LVZ), and VF parameters: 10-2 PSD and 10-2 MD.

Conclusions : HTN was not significantly associated with progression using any parameter. However, based on ranked model fits, macular structural and functional parameters had best performance fitting the progression data, suggesting their usefulness as endpoints. Studies defining HTN based on 24-hour BP monitoring and including modalities of treatment may better elucidate whether this prevalent systemic disease is an independent risk factor for glaucoma progression.

This is a 2021 ARVO Annual Meeting abstract.