To evaluate the potential benefit of intraocular pressure (IOP) reduction in normal-tension glaucoma (NTG) patients in South Korea. A retrospective, multi-center analysis of Korean NTG patients with 5-years follow-up, typical glaucomatous optic disc and/or visual field changes and no recorded IOP >21 mmHg. Progression was identified by Advanced Glaucoma Intervention Study visual field scoring. There were 90 (42%) progressed patients and 127 (58%) stable patients included in the study. Mean IOP measured higher in the progressed (14.3 ± 2.2 mmHg) than stable patients (14.0 ± 1.9 mmHg), but was not statistically different between the groups (P = 0.29). The mean IOP that best discriminated stable patients was ≤15 mmHg, but no statistical difference existed in the numbers of progressed versus stable patients at ≤15 mmHg compared to >15 mmHg (P = 0.07). Multivariate regression analysis showed that the baseline number of glaucoma medicines and visual field as well as mean, peak and fluctuation of IOP were significant risk factors for glaucomatous progression (P < 0.01). This study suggests that in Korean NTG patients, despite relatively similar IOPs between progressed and stable patients, and based on multivariate regression analysis, IOP may be a risk factor for glaucomatous progression.
[Show abstract][Hide abstract] ABSTRACT: Increased intraocular pressure (IOP) is a major risk factor for glaucomatous damage and reducing IOP improves prognosis. Nevertheless, there is little doubt that other risk factors besides IOP such as unstable ocular perfusion are involved. Blood flow is unstable if either the IOP fluctuates at a high level (or blood pressure fluctuates at a low level) or if the autoregulation of blood flow disturbed. A common cause for a disturbed OBF autoregulation is a primary vascular dysregulation (PVD) frequently observed in normal tension glaucoma patients. An unstable blood flow leads to recurrent mild reperfusion injury (chronic oxidative stress) affecting particularly the mitochondria of the optic nerve head. OBF regulation can be improved by magnesium, calcium channel blockers as well as with carbonic anhydrase inhibitors.
Current Opinion in Pharmacology 10/2012; 13(1). DOI:10.1016/j.coph.2012.10.001 · 4.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose:
To determine the risk factors of visual field (VF) progression in relatively low and high intraocular pressure (IOP) groups in normal tension glaucoma (NTG) patients and to compare progression rate of VF defects between the 2 groups.
Forty-nine eyes of 49 NTG patients with untreated IOP of ≤15 mm Hg (group A) and 49 eyes of 49 NTG patients matched by age and baseline VF mean deviation (MD) who had untreated IOP of >15 mm Hg (group B) were included in this retrospective chart review study. All patients were followed >5 years. Risk factors for VF progression were evaluated using Cox proportional hazards models in each group, separately. Changes in VF indexes were compared between the 2 groups.
Mean IOP and IOP fluctuation were significantly greater in group B than in group A (P<0.001 and P=0.016), whereas other factors did not differ between the groups. In multivariable analysis, VF progression was significantly associated with disc hemorrhage in group A (HR, 6.19; P=0.017) and mean IOP in group B (HR, 1.77; P=0.029). There was no significant difference between the groups in incidence of progression and in changes of MD, pattern SD, and VF index (P=0.942, 0.874, and 0.887, respectively).
Although progression rate was similar, the risk factors for VF progression were different in the 2 groups. These findings may suggest that IOP-dependent and IOP-independent factors affect VF progression differently in the 2 groups.
Journal of glaucoma 06/2013; 23(8). DOI:10.1097/IJG.0b013e31829484c6 · 2.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
To identify systemic and ocular risk factors associated with open angle glaucoma with normal baseline intraocular pressure(IOP) in a young Korean population.DesignRetrospective, population based cross-sectional case-control study.ParticipantsBetween 2009 and 2010, among participants from the Korea National Health and Nutrition Examination Survey(KNHANES)(n =17,901), subjects between 19 to 39 years of age were included.Methods
Participants had structured interviews and systemic examination. The ophthalmologic examination included autorefraction, applanation tonometry, slit lamp examination and fundus photography. For participants meeting the glaucoma suspicion criteria, frequency doubling perimetry testing with the screening program N-30-1 was performed. Glaucoma was diagnosed using International Society of Geographical and Epidemiological Ophthalmology criteria.Main Outcome MeasuresThe systemic and ocular risk factors for open angle glaucoma with normal baseline IOP were analyzed using univariate and multivariate comparisons.ResultsEighty open angle glaucoma with normal baseline IOP patients and 4015 controls were included. In the univariate analysis, patient group were more likely to have higher fasting plasma glucose(FPG)(98.04±33.16 vs. 89.74±12.65, p <0.001) and higher proportion of fasting capillary glucose(FCG)≥200 mg/dL(p <0.001) than control. Multivariate analysis found that high myopia(OR, 3.54 [95% CI,1.34- 9.39], p=0.011), FCG≥200 mg/dL(OR, 12.65 [95% CI, 2.63, 60.94],p=0.002) and low high density lipoprotein cholesterol(HDL-C)(OR, 0.96 [95% CI, 0.94- 0.99],p=0.015) were associated with an increased risk of having open angle glaucoma with normal baseline IOP.Conclusions
High myopia, FCG level≥200mmol/L and low HDL cholesterol level were significant risk factors for open angle glaucoma with normal baseline IOP in a young Korean population.
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