Natural history of normal-tension glaucoma

W. L M Alward, F. Feldman, G. Trope, L. F. Cashwell, J. Wilensky, H. C. Geijssen, E. Greeve, H. Quigley, H. Jampel, J. Hopkins, G. Skuta, P. R. Lichter, P. Blondeau, Douglas Anderson, Alana Lee Grajewski, E. Hodapp, G. Balazsi, M. Amyot, D. C. Desjardins, R. Z. LeveneD. Minckler, D. Heuer, S. M. Drance, F. Mikelberg, G. Douglas, M. Johnstone, J. Hetherington, H. D. Hoskins, I. P. Pollack, D. Abrams, R. Mills, O. P. Kasner, A. Schwartz, J. Liebmann, R. Ritch, J. Cohen, A. Tuulonen, P. J. Airaksinen

Research output: Contribution to journalArticle

205 Citations (Scopus)

Abstract

Objective: A recently reported randomized study described the role of intraocular pressure (IOP) in normal-tension glaucoma (NTG) pathogenesis and the effect of therapeutic lowering of IOP. This is a report of an analysis of the natural course of NTG during the time eyes were not receiving therapy, either in the time interval awaiting randomization or after being randomly assigned not to receive treatment to lower the IOP. Design: Analysis of prospectively collected data on the long-term course of a cohort of untreated subjects with normal-tension glaucoma, a subset of subjects enrolled in a randomized controlled clinical trial. Randomization and Subject Selection: If the field defect in the study eye threatened the point of fixation, the subject was randomly assigned to start on treatment immediately or to be observed without treatment until progression was documented. Otherwise, an eye was randomly assigned only when and if, subsequent to enrollment, it showed visual field progression, progression of optic disc cupping, or a new disc hemorrhage. Participants: Data were collected for this report on 160 subjects observed without treatment among a total enrollment of 260. They consist of 49 subjects who were randomly assigned on enrollment not to receive therapy, 24 followed without treatment for a time until later being randomly assigned to treatment, 31 similarly followed without treatment and who were later randomly assigned to be followed for an additional time without treatment, and 56 who enrolled but were never randomly assigned. Main Outcome Measures: Visual field data were used in this report only from the interval during which the eye had not been assigned to receive therapy and were analyzed by two measures of progression: the "survival" time to meeting a criterion of confirmed localized progression and the rate of change in the mean deviation (MD) index over time. Results: The four subgroups just described were similar at baseline, except that the average MD index was slightly better for the 56 eyes that never progressed during the period of follow-up. By Kaplan-Meier analysis of all untreated subjects combined, approximately one third showed localized progression within 3 years and about half within 5 to 7 years. Of subjects followed for 3 years or more, 62 of 109 did not show a statistically significant negative slope of MD regressed over time, whereas the others showed a statistically significant MD decline, mainly between -0.2 and -2 db per year. Conclusions: Some cases of NTG progress more rapidly than others. Although approximately half of cases showed a confirmed localized visual field deterioration by 7 years, the change is typically small and slow, often insufficient to measurably affect the MD index.

Original languageEnglish
Pages (from-to)247-253
Number of pages7
JournalOphthalmology
Volume108
Issue number2
DOIs
StatePublished - Feb 14 2001
Externally publishedYes

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Low Tension Glaucoma
Visual Fields
Intraocular Pressure
Random Allocation
Optic Disk
Kaplan-Meier Estimate
Therapeutic Uses
Patient Selection
Therapeutics
Randomized Controlled Trials
Outcome Assessment (Health Care)
Hemorrhage

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Alward, W. L. M., Feldman, F., Trope, G., Cashwell, L. F., Wilensky, J., Geijssen, H. C., ... Airaksinen, P. J. (2001). Natural history of normal-tension glaucoma. Ophthalmology, 108(2), 247-253. https://doi.org/10.1016/S0161-6420(00)00518-2

Natural history of normal-tension glaucoma. / Alward, W. L M; Feldman, F.; Trope, G.; Cashwell, L. F.; Wilensky, J.; Geijssen, H. C.; Greeve, E.; Quigley, H.; Jampel, H.; Hopkins, J.; Skuta, G.; Lichter, P. R.; Blondeau, P.; Anderson, Douglas; Grajewski, Alana Lee; Hodapp, E.; Balazsi, G.; Amyot, M.; Desjardins, D. C.; Levene, R. Z.; Minckler, D.; Heuer, D.; Drance, S. M.; Mikelberg, F.; Douglas, G.; Johnstone, M.; Hetherington, J.; Hoskins, H. D.; Pollack, I. P.; Abrams, D.; Mills, R.; Kasner, O. P.; Schwartz, A.; Liebmann, J.; Ritch, R.; Cohen, J.; Tuulonen, A.; Airaksinen, P. J.

In: Ophthalmology, Vol. 108, No. 2, 14.02.2001, p. 247-253.

Research output: Contribution to journalArticle

Alward, WLM, Feldman, F, Trope, G, Cashwell, LF, Wilensky, J, Geijssen, HC, Greeve, E, Quigley, H, Jampel, H, Hopkins, J, Skuta, G, Lichter, PR, Blondeau, P, Anderson, D, Grajewski, AL, Hodapp, E, Balazsi, G, Amyot, M, Desjardins, DC, Levene, RZ, Minckler, D, Heuer, D, Drance, SM, Mikelberg, F, Douglas, G, Johnstone, M, Hetherington, J, Hoskins, HD, Pollack, IP, Abrams, D, Mills, R, Kasner, OP, Schwartz, A, Liebmann, J, Ritch, R, Cohen, J, Tuulonen, A & Airaksinen, PJ 2001, 'Natural history of normal-tension glaucoma', Ophthalmology, vol. 108, no. 2, pp. 247-253. https://doi.org/10.1016/S0161-6420(00)00518-2
Alward WLM, Feldman F, Trope G, Cashwell LF, Wilensky J, Geijssen HC et al. Natural history of normal-tension glaucoma. Ophthalmology. 2001 Feb 14;108(2):247-253. https://doi.org/10.1016/S0161-6420(00)00518-2
Alward, W. L M ; Feldman, F. ; Trope, G. ; Cashwell, L. F. ; Wilensky, J. ; Geijssen, H. C. ; Greeve, E. ; Quigley, H. ; Jampel, H. ; Hopkins, J. ; Skuta, G. ; Lichter, P. R. ; Blondeau, P. ; Anderson, Douglas ; Grajewski, Alana Lee ; Hodapp, E. ; Balazsi, G. ; Amyot, M. ; Desjardins, D. C. ; Levene, R. Z. ; Minckler, D. ; Heuer, D. ; Drance, S. M. ; Mikelberg, F. ; Douglas, G. ; Johnstone, M. ; Hetherington, J. ; Hoskins, H. D. ; Pollack, I. P. ; Abrams, D. ; Mills, R. ; Kasner, O. P. ; Schwartz, A. ; Liebmann, J. ; Ritch, R. ; Cohen, J. ; Tuulonen, A. ; Airaksinen, P. J. / Natural history of normal-tension glaucoma. In: Ophthalmology. 2001 ; Vol. 108, No. 2. pp. 247-253.
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abstract = "Objective: A recently reported randomized study described the role of intraocular pressure (IOP) in normal-tension glaucoma (NTG) pathogenesis and the effect of therapeutic lowering of IOP. This is a report of an analysis of the natural course of NTG during the time eyes were not receiving therapy, either in the time interval awaiting randomization or after being randomly assigned not to receive treatment to lower the IOP. Design: Analysis of prospectively collected data on the long-term course of a cohort of untreated subjects with normal-tension glaucoma, a subset of subjects enrolled in a randomized controlled clinical trial. Randomization and Subject Selection: If the field defect in the study eye threatened the point of fixation, the subject was randomly assigned to start on treatment immediately or to be observed without treatment until progression was documented. Otherwise, an eye was randomly assigned only when and if, subsequent to enrollment, it showed visual field progression, progression of optic disc cupping, or a new disc hemorrhage. Participants: Data were collected for this report on 160 subjects observed without treatment among a total enrollment of 260. They consist of 49 subjects who were randomly assigned on enrollment not to receive therapy, 24 followed without treatment for a time until later being randomly assigned to treatment, 31 similarly followed without treatment and who were later randomly assigned to be followed for an additional time without treatment, and 56 who enrolled but were never randomly assigned. Main Outcome Measures: Visual field data were used in this report only from the interval during which the eye had not been assigned to receive therapy and were analyzed by two measures of progression: the {"}survival{"} time to meeting a criterion of confirmed localized progression and the rate of change in the mean deviation (MD) index over time. Results: The four subgroups just described were similar at baseline, except that the average MD index was slightly better for the 56 eyes that never progressed during the period of follow-up. By Kaplan-Meier analysis of all untreated subjects combined, approximately one third showed localized progression within 3 years and about half within 5 to 7 years. Of subjects followed for 3 years or more, 62 of 109 did not show a statistically significant negative slope of MD regressed over time, whereas the others showed a statistically significant MD decline, mainly between -0.2 and -2 db per year. Conclusions: Some cases of NTG progress more rapidly than others. Although approximately half of cases showed a confirmed localized visual field deterioration by 7 years, the change is typically small and slow, often insufficient to measurably affect the MD index.",
author = "Alward, {W. L M} and F. Feldman and G. Trope and Cashwell, {L. F.} and J. Wilensky and Geijssen, {H. C.} and E. Greeve and H. Quigley and H. Jampel and J. Hopkins and G. Skuta and Lichter, {P. R.} and P. Blondeau and Douglas Anderson and Grajewski, {Alana Lee} and E. Hodapp and G. Balazsi and M. Amyot and Desjardins, {D. C.} and Levene, {R. Z.} and D. Minckler and D. Heuer and Drance, {S. M.} and F. Mikelberg and G. Douglas and M. Johnstone and J. Hetherington and Hoskins, {H. D.} and Pollack, {I. P.} and D. Abrams and R. Mills and Kasner, {O. P.} and A. Schwartz and J. Liebmann and R. Ritch and J. Cohen and A. Tuulonen and Airaksinen, {P. J.}",
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TY - JOUR

T1 - Natural history of normal-tension glaucoma

AU - Alward, W. L M

AU - Feldman, F.

AU - Trope, G.

AU - Cashwell, L. F.

AU - Wilensky, J.

AU - Geijssen, H. C.

AU - Greeve, E.

AU - Quigley, H.

AU - Jampel, H.

AU - Hopkins, J.

AU - Skuta, G.

AU - Lichter, P. R.

AU - Blondeau, P.

AU - Anderson, Douglas

AU - Grajewski, Alana Lee

AU - Hodapp, E.

AU - Balazsi, G.

AU - Amyot, M.

AU - Desjardins, D. C.

AU - Levene, R. Z.

AU - Minckler, D.

AU - Heuer, D.

AU - Drance, S. M.

AU - Mikelberg, F.

AU - Douglas, G.

AU - Johnstone, M.

AU - Hetherington, J.

AU - Hoskins, H. D.

AU - Pollack, I. P.

AU - Abrams, D.

AU - Mills, R.

AU - Kasner, O. P.

AU - Schwartz, A.

AU - Liebmann, J.

AU - Ritch, R.

AU - Cohen, J.

AU - Tuulonen, A.

AU - Airaksinen, P. J.

PY - 2001/2/14

Y1 - 2001/2/14

N2 - Objective: A recently reported randomized study described the role of intraocular pressure (IOP) in normal-tension glaucoma (NTG) pathogenesis and the effect of therapeutic lowering of IOP. This is a report of an analysis of the natural course of NTG during the time eyes were not receiving therapy, either in the time interval awaiting randomization or after being randomly assigned not to receive treatment to lower the IOP. Design: Analysis of prospectively collected data on the long-term course of a cohort of untreated subjects with normal-tension glaucoma, a subset of subjects enrolled in a randomized controlled clinical trial. Randomization and Subject Selection: If the field defect in the study eye threatened the point of fixation, the subject was randomly assigned to start on treatment immediately or to be observed without treatment until progression was documented. Otherwise, an eye was randomly assigned only when and if, subsequent to enrollment, it showed visual field progression, progression of optic disc cupping, or a new disc hemorrhage. Participants: Data were collected for this report on 160 subjects observed without treatment among a total enrollment of 260. They consist of 49 subjects who were randomly assigned on enrollment not to receive therapy, 24 followed without treatment for a time until later being randomly assigned to treatment, 31 similarly followed without treatment and who were later randomly assigned to be followed for an additional time without treatment, and 56 who enrolled but were never randomly assigned. Main Outcome Measures: Visual field data were used in this report only from the interval during which the eye had not been assigned to receive therapy and were analyzed by two measures of progression: the "survival" time to meeting a criterion of confirmed localized progression and the rate of change in the mean deviation (MD) index over time. Results: The four subgroups just described were similar at baseline, except that the average MD index was slightly better for the 56 eyes that never progressed during the period of follow-up. By Kaplan-Meier analysis of all untreated subjects combined, approximately one third showed localized progression within 3 years and about half within 5 to 7 years. Of subjects followed for 3 years or more, 62 of 109 did not show a statistically significant negative slope of MD regressed over time, whereas the others showed a statistically significant MD decline, mainly between -0.2 and -2 db per year. Conclusions: Some cases of NTG progress more rapidly than others. Although approximately half of cases showed a confirmed localized visual field deterioration by 7 years, the change is typically small and slow, often insufficient to measurably affect the MD index.

AB - Objective: A recently reported randomized study described the role of intraocular pressure (IOP) in normal-tension glaucoma (NTG) pathogenesis and the effect of therapeutic lowering of IOP. This is a report of an analysis of the natural course of NTG during the time eyes were not receiving therapy, either in the time interval awaiting randomization or after being randomly assigned not to receive treatment to lower the IOP. Design: Analysis of prospectively collected data on the long-term course of a cohort of untreated subjects with normal-tension glaucoma, a subset of subjects enrolled in a randomized controlled clinical trial. Randomization and Subject Selection: If the field defect in the study eye threatened the point of fixation, the subject was randomly assigned to start on treatment immediately or to be observed without treatment until progression was documented. Otherwise, an eye was randomly assigned only when and if, subsequent to enrollment, it showed visual field progression, progression of optic disc cupping, or a new disc hemorrhage. Participants: Data were collected for this report on 160 subjects observed without treatment among a total enrollment of 260. They consist of 49 subjects who were randomly assigned on enrollment not to receive therapy, 24 followed without treatment for a time until later being randomly assigned to treatment, 31 similarly followed without treatment and who were later randomly assigned to be followed for an additional time without treatment, and 56 who enrolled but were never randomly assigned. Main Outcome Measures: Visual field data were used in this report only from the interval during which the eye had not been assigned to receive therapy and were analyzed by two measures of progression: the "survival" time to meeting a criterion of confirmed localized progression and the rate of change in the mean deviation (MD) index over time. Results: The four subgroups just described were similar at baseline, except that the average MD index was slightly better for the 56 eyes that never progressed during the period of follow-up. By Kaplan-Meier analysis of all untreated subjects combined, approximately one third showed localized progression within 3 years and about half within 5 to 7 years. Of subjects followed for 3 years or more, 62 of 109 did not show a statistically significant negative slope of MD regressed over time, whereas the others showed a statistically significant MD decline, mainly between -0.2 and -2 db per year. Conclusions: Some cases of NTG progress more rapidly than others. Although approximately half of cases showed a confirmed localized visual field deterioration by 7 years, the change is typically small and slow, often insufficient to measurably affect the MD index.

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