Abstract
Purpose :
To evaluate rates of visual field loss in eyes with optic nerve head drusen (ONHD) and to investigate their relationship with intraocular pressure (IOP).
Methods :
This was a retrospective cohort study involving patients with ONHD from the Duke Ophthalmic Registry. All records from eyes with at least 12 months of follow-up and at least 2 reliable standard automated perimetry (SAP) tests were included. Linear mixed models were used to estimate rates of SAP mean deviation (MD) loss over time. Rates of progression were classified in slow (slower than -0.5dB/y), moderate (between -0.5dB/y and -1db/y) and fast (faster than -1dB/y). Univariable and multivariable models were used to assess the effect of mean IOP and other clinical variables such as age, race and baseline MD, on rates of change.
Results :
The study included 109 eyes of 66 subjects with ONHD followed for an average of 5.6 ± 4.3 years. 27 eyes (24.8%) were treated with IOP lowering drugs during follow-up. Eyes had a mean IOP during follow-up of 14.9 ± 2.5 mmHg. The mean rate of SAP MD change was -0.20 ± 0.18 dB/year, ranging from -1.10 to 0.22 dB/year. 102 (93.6%), 6(5.5%) and 1(0.9%) of eyes had slow, moderate, and fast progression, respectively. There was no statistically significant difference in rates of change between eyes receiving IOP lowering drugs and eyes that did not receive IOP lowering medication (P=0.441). Higher mean IOP during follow-up was not associated with faster rates of MD change in both univariable (P=0.131) and multivariable (P=0.435) models. In a multivariable model including mean IOP, age, gender, race, and baseline SAP MD, only age at baseline was significantly associated with faster rates of SAP MD loss with 0.07 dB/year faster rate of loss for each decade older (P=0.003).
Conclusions :
Most eyes with ONHD have a slow progression of MD loss over time. We were not able to find a statistically significant relationship between mean IOP and rates of visual field loss, which suggests that there may not be a clear benefit of IOP lowering treatment in eyes with ONHD. Older age was significantly associated with faster rates of visual field loss.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.