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Baseline Central Visual Field Defect as a Risk Factor For NTG Progression

A 5-Year Prospective Study

Raman, Puspha MBBCh, BAO (NUI), M.Ophthal (UM), FICO*; Suliman, Nurull B. M.Ophthal (UM)*; Zahari, Mimiwati MBBS (UM), FRCS (Edin) M.Ophthal (UM)*; Mohamad, Nor Fadhilah MBBS (UM), M.Ophthal (UM)*; Kook, Michael S. MD; Ramli, Norlina MBBS (UK), MRCOPth (UK), MS Ophthal (UM)*

doi: 10.1097/IJG.0000000000001359
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Precis: This 5-year follow-up study on normal-tension glaucoma (NTG) patients demonstrated that those with baseline central visual field (VF) defect progress at a more increased rate compared with those with peripheral field defect.

Purpose: The purpose of this study was to investigate the clinical characteristics, including 24-hour ocular perfusion pressure and risk of progression in patients with baseline central VF defect, as compared with those with peripheral VF defect in NTG.

Design: This was a prospective, longitudinal study.

Methods: A total of 65 NTG patients who completed 5 years of follow-up were included in this study. All the enrolled patients underwent baseline 24-hour intraocular pressure and blood pressure monitoring via 2-hourly measurements in their habitual position and had ≥5 reliable VF tests during the 5-year follow-up. Patients were assigned to two groups on the basis of VF defect locations at baseline, the central 10 degrees, and the peripheral 10- to 24-degree area. Modified Anderson criteria were used to assess global VF progression over 5 years. Kaplan-Meier analyses were used to compare the elapsed time of confirmed VF progression in the two groups. Hazard ratios for the association between clinical risk factors and VF progression were obtained by using Cox proportional hazards models.

Results: There were no significant differences between the patients with baseline central and peripheral VF defects in terms of demography, clinical, ocular and systemic hemodynamic factors. Eyes with baseline defects involving the central fields progressed faster (difference: βcentral=−0.78 dB/y, 95% confidence interval=−0.22 to −1.33, P=0.007) and have 3.56 times higher hazard of progressing (95% confidence interval=1.17-10.82, P=0.025) than those with only peripheral defects.

Conclusion: NTG patients with baseline central VF involvement are at increased risk of progression compared with those with peripheral VF defect.

*Department of Ophthalmology, Faculty of Medicine, University of Malaya Eye Research Centre, Kuala Lumpur, Malaysia

Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Korea

Disclosure: The authors declare no conflict of interest.

Reprints: Puspha Raman, MBBCh, BAO (NUI), M.Ophthal (UM), FICO, Department of Ophthalmology, Faculty of Medicine, University of Malaya Eye Research Centre, Kuala Lumpur 50603, Malaysia (e-mail: puspha@gmail.com).

Received May 6, 2019

Accepted August 7, 2019

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