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Abstract #99103 Published in IGR 22-4
Long-term Intraocular Pressure Fluctuation is a Risk Factor for Visual Field Progression in Advanced Glaucoma
Lee JS; Park S; Seong GJ; Kim CY; Lee SY; Choi W; Bae HWJournal of Glaucoma 2022; 31: 310-316
PRECIS: IOP fluctuations increase the risk of visual field progression of primary open-angle glaucoma in advanced stage even when IOP is maintained low on average. PURPOSE: To identify risk factors associated with progression of visual field defect in patients with advanced primary open-angle glaucoma (POAG). METHODS: A retrospective review of medical records was conducted to identify patients who met the Hodapp-Parrish-Anderson criteria for advanced POAG. 122 eyes of 122 patients had undergone intraocular pressure (IOP) measurement with Goldmann applanation tonometer (GAT), standard automated perimetry (SAP), cirrus optical coherence tomography (OCT) and fundus photography at 6-month intervals. Visual field progression was defined as deterioration of a minimum of 3 visual field locations more than baseline at 5% levels in 4 consecutive visual fields with 24-2 SITA testing. RESULTS: Thirty-six eyes of 122 eyes (29.5%, 51.9±13.9▒y old) showed visual field progression during 100.7±44.2 months of follow-up. The progression group showed greater long-term IOP fluctuations (2.6±1.4▒mmHg) than the no progression group (53.5±13.5▒y; 2.0±1.0▒mmHg, P=0.008). Disc hemorrhage was detected more frequently in the progression group (40.5% vs. 17.4%, P=0.005). Multivariate Cox regression analysis revealed long-term IOP fluctuations (HR 2.567 95% CI 1.327-5.370, P=0.012) and disc hemorrhage (HR 2.351 95% CI 1.120-4.931, P=0.024) to be independent risk factors of visual field progression. Patients who showed both disc hemorrhage and long-term IOP fluctuations were at greater risks of progression (HR 2.675 95% CI 1.072-6.457, P=0.035). CONCLUSIONS: Long-term IOP fluctuations and disc hemorrhage are independent and additive risk factors of visual field progression in advanced glaucoma even at low intraocular pressures. Patients in whom these risk factors are identified require close monitoring and vigorous treatment.
Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine.
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