Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures

Douglas Anderson, S. M. Drance, M. Schulzer

Research output: Contribution to journalArticle

1089 Citations (Scopus)

Abstract

PURPOSE: To determine if intraocular pressure plays a part in the pathogenic process of normal-tension glaucoma. METHODS: One eye of each eligible subject was randomized either to be untreated as a control or to have intraocular pressure lowered by 30% from baseline. Eyes were randomized if they met criteria for diagnosis of normal-tension glaucoma and showed documented progression or high-risk field defects that threatened fixation or the appearance of a new disk hemorrhage. The clinical course (visual field and optic disk) of the group with lowered intraocular pressure was compared with the clinical course when intraocular pressure remained at its spontaneous untreated level. RESULTS: One hundred-forty eyes of 140 patients were used in this study. Sixty-one were in the treatment group, and 79 were untreated controls. Twenty-eight (35%) of the control eyes and 7 (12%) of the treated eyes reached end points (specifically defined criteria of glaucomatous optic disk progression or visual field loss). An overall survival analysis showed a statistically significant difference between the two groups (P < .0001). The mean survival time ± SD of the treated group was 2,688 ± 123 days and for the control group, 1,695 ± 143 days. Of 34 cataracts developed during the study, 11 (14%) occurred in the control group and 23 (38%) in the treated group (P = .0075), with the highest incidence in those whose treatment included filtration surgery. CONCLUSIONS: Intraocular pressure is part of the pathogenic process in normal-tension glaucoma. Therapy that is effective in lowering intraocular pressure and free of adverse effects would be expected to be beneficial in patients who are at risk of disease progression.

Original languageEnglish
Pages (from-to)487-497
Number of pages11
JournalAmerican Journal of Ophthalmology
Volume126
Issue number4
DOIs
StatePublished - Oct 1 1998
Externally publishedYes

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Low Tension Glaucoma
Intraocular Pressure
Optic Disk
Visual Fields
Filtering Surgery
Control Groups
Survival Analysis
Cataract
Disease Progression
Therapeutics
Survival Rate
Hemorrhage
Incidence

ASJC Scopus subject areas

  • Ophthalmology

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Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. / Anderson, Douglas; Drance, S. M.; Schulzer, M.

In: American Journal of Ophthalmology, Vol. 126, No. 4, 01.10.1998, p. 487-497.

Research output: Contribution to journalArticle

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abstract = "PURPOSE: To determine if intraocular pressure plays a part in the pathogenic process of normal-tension glaucoma. METHODS: One eye of each eligible subject was randomized either to be untreated as a control or to have intraocular pressure lowered by 30{\%} from baseline. Eyes were randomized if they met criteria for diagnosis of normal-tension glaucoma and showed documented progression or high-risk field defects that threatened fixation or the appearance of a new disk hemorrhage. The clinical course (visual field and optic disk) of the group with lowered intraocular pressure was compared with the clinical course when intraocular pressure remained at its spontaneous untreated level. RESULTS: One hundred-forty eyes of 140 patients were used in this study. Sixty-one were in the treatment group, and 79 were untreated controls. Twenty-eight (35{\%}) of the control eyes and 7 (12{\%}) of the treated eyes reached end points (specifically defined criteria of glaucomatous optic disk progression or visual field loss). An overall survival analysis showed a statistically significant difference between the two groups (P < .0001). The mean survival time ± SD of the treated group was 2,688 ± 123 days and for the control group, 1,695 ± 143 days. Of 34 cataracts developed during the study, 11 (14{\%}) occurred in the control group and 23 (38{\%}) in the treated group (P = .0075), with the highest incidence in those whose treatment included filtration surgery. CONCLUSIONS: Intraocular pressure is part of the pathogenic process in normal-tension glaucoma. Therapy that is effective in lowering intraocular pressure and free of adverse effects would be expected to be beneficial in patients who are at risk of disease progression.",
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