Risk factors for visual field progression in the low-pressure glaucoma treatment study

Carlos Gustavo De Moraes, Jeffrey M. Liebmann, David Greenfield, Stuart K. Gardiner, Robert Ritch, Theodore Krupin

Research output: Contribution to journalArticle

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Abstract

Purpose: To investigate risk factors associated with visual field progression in the Low-pressure Glaucoma Treatment Study, a prospective trial designed to compare the effects of the alpha2-adrenergic agonist brimonidine tartrate 0.2% to the beta-adrenergic antagonist timolol maleate 0.5% on visual function in low-pressure glaucoma. Design: Prospective cohort study. Methods: Low-pressure Glaucoma Treatment Study patients with <5 visual field tests during follow-up were included. Progression was determined using pointwise linear regression analysis, defined as the same 3 or more visual field locations with a slope more negative than -1.0 dB/year at P < 5%, on 3 consecutive tests. Ocular and systemic risk factors were analyzed using Cox proportional hazards model and further tested for independence in a multivariate model. Results: A total of 253 eyes of 127 subjects (mean age, 64.7 ± 10.9 years; mean follow-up, 40.6 ± 12 months) were analyzed. Eyes randomized to timolol progressed faster than those randomized to brimonidine (mean rates of progression, -0.38 ± 0.9 vs 0.02 ± 0.7 dB/y, P <.01). In the final multivariate model adjusting for all tested covariates, older age (hazard ratio [HR] = 1.41/decade older, 95% confidence interval [CI] = 1.05 to 1.90, P =.022), use of systemic antihypertensives (HR = 2.53, 95% CI = 1.32 to 4.87, P =.005), and mean ocular perfusion pressure (HR = 1.21/mm Hg lower, 95% CI = 1.12 to 1.31, P <.001) were associated with progression whereas randomization to brimonidine revealed a protective effect (HR = 0.26, 95% CI = 0.12 to 0.55, P <.001). Conclusions: While randomization to brimonidine 0.2% was protective compared to timolol 0.5%, lower mean ocular perfusion pressure increased the risk for reaching a progression outcome in the Low-pressure Glaucoma Treatment Study. This suggests that the beneficial effect of randomization to the brimonidine arm was independent of possible differences in ocular perfusion pressures between the 2 treatment arms. The current results and large number of drop-outs in the brimonidine 0.2% arm suggest that more research is necessary before altering clinical practice paradigms.

Original languageEnglish
Pages (from-to)702-711
Number of pages10
JournalAmerican Journal of Ophthalmology
Volume154
Issue number4
DOIs
StatePublished - Oct 1 2012

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Visual Fields
Glaucoma
Pressure
Timolol
Random Allocation
Confidence Intervals
Arm
Perfusion
Therapeutics
Adrenergic alpha-2 Receptor Agonists
Prospective Studies
Visual Field Tests
Adrenergic beta-Antagonists
Proportional Hazards Models
Antihypertensive Agents
Brimonidine Tartrate
Linear Models
Cohort Studies
Regression Analysis
Research

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Risk factors for visual field progression in the low-pressure glaucoma treatment study. / De Moraes, Carlos Gustavo; Liebmann, Jeffrey M.; Greenfield, David; Gardiner, Stuart K.; Ritch, Robert; Krupin, Theodore.

In: American Journal of Ophthalmology, Vol. 154, No. 4, 01.10.2012, p. 702-711.

Research output: Contribution to journalArticle

De Moraes, Carlos Gustavo ; Liebmann, Jeffrey M. ; Greenfield, David ; Gardiner, Stuart K. ; Ritch, Robert ; Krupin, Theodore. / Risk factors for visual field progression in the low-pressure glaucoma treatment study. In: American Journal of Ophthalmology. 2012 ; Vol. 154, No. 4. pp. 702-711.
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abstract = "Purpose: To investigate risk factors associated with visual field progression in the Low-pressure Glaucoma Treatment Study, a prospective trial designed to compare the effects of the alpha2-adrenergic agonist brimonidine tartrate 0.2{\%} to the beta-adrenergic antagonist timolol maleate 0.5{\%} on visual function in low-pressure glaucoma. Design: Prospective cohort study. Methods: Low-pressure Glaucoma Treatment Study patients with <5 visual field tests during follow-up were included. Progression was determined using pointwise linear regression analysis, defined as the same 3 or more visual field locations with a slope more negative than -1.0 dB/year at P < 5{\%}, on 3 consecutive tests. Ocular and systemic risk factors were analyzed using Cox proportional hazards model and further tested for independence in a multivariate model. Results: A total of 253 eyes of 127 subjects (mean age, 64.7 ± 10.9 years; mean follow-up, 40.6 ± 12 months) were analyzed. Eyes randomized to timolol progressed faster than those randomized to brimonidine (mean rates of progression, -0.38 ± 0.9 vs 0.02 ± 0.7 dB/y, P <.01). In the final multivariate model adjusting for all tested covariates, older age (hazard ratio [HR] = 1.41/decade older, 95{\%} confidence interval [CI] = 1.05 to 1.90, P =.022), use of systemic antihypertensives (HR = 2.53, 95{\%} CI = 1.32 to 4.87, P =.005), and mean ocular perfusion pressure (HR = 1.21/mm Hg lower, 95{\%} CI = 1.12 to 1.31, P <.001) were associated with progression whereas randomization to brimonidine revealed a protective effect (HR = 0.26, 95{\%} CI = 0.12 to 0.55, P <.001). Conclusions: While randomization to brimonidine 0.2{\%} was protective compared to timolol 0.5{\%}, lower mean ocular perfusion pressure increased the risk for reaching a progression outcome in the Low-pressure Glaucoma Treatment Study. This suggests that the beneficial effect of randomization to the brimonidine arm was independent of possible differences in ocular perfusion pressures between the 2 treatment arms. The current results and large number of drop-outs in the brimonidine 0.2{\%} arm suggest that more research is necessary before altering clinical practice paradigms.",
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AU - Liebmann, Jeffrey M.

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AU - Gardiner, Stuart K.

AU - Ritch, Robert

AU - Krupin, Theodore

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N2 - Purpose: To investigate risk factors associated with visual field progression in the Low-pressure Glaucoma Treatment Study, a prospective trial designed to compare the effects of the alpha2-adrenergic agonist brimonidine tartrate 0.2% to the beta-adrenergic antagonist timolol maleate 0.5% on visual function in low-pressure glaucoma. Design: Prospective cohort study. Methods: Low-pressure Glaucoma Treatment Study patients with <5 visual field tests during follow-up were included. Progression was determined using pointwise linear regression analysis, defined as the same 3 or more visual field locations with a slope more negative than -1.0 dB/year at P < 5%, on 3 consecutive tests. Ocular and systemic risk factors were analyzed using Cox proportional hazards model and further tested for independence in a multivariate model. Results: A total of 253 eyes of 127 subjects (mean age, 64.7 ± 10.9 years; mean follow-up, 40.6 ± 12 months) were analyzed. Eyes randomized to timolol progressed faster than those randomized to brimonidine (mean rates of progression, -0.38 ± 0.9 vs 0.02 ± 0.7 dB/y, P <.01). In the final multivariate model adjusting for all tested covariates, older age (hazard ratio [HR] = 1.41/decade older, 95% confidence interval [CI] = 1.05 to 1.90, P =.022), use of systemic antihypertensives (HR = 2.53, 95% CI = 1.32 to 4.87, P =.005), and mean ocular perfusion pressure (HR = 1.21/mm Hg lower, 95% CI = 1.12 to 1.31, P <.001) were associated with progression whereas randomization to brimonidine revealed a protective effect (HR = 0.26, 95% CI = 0.12 to 0.55, P <.001). Conclusions: While randomization to brimonidine 0.2% was protective compared to timolol 0.5%, lower mean ocular perfusion pressure increased the risk for reaching a progression outcome in the Low-pressure Glaucoma Treatment Study. This suggests that the beneficial effect of randomization to the brimonidine arm was independent of possible differences in ocular perfusion pressures between the 2 treatment arms. The current results and large number of drop-outs in the brimonidine 0.2% arm suggest that more research is necessary before altering clinical practice paradigms.

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