{"title":"Glaucoma Progression in Treatment-Naïve Normal-Tension Glaucoma Patients with Myopia - Role of Intraocular Pressure.","authors":"Dong Kyun Han, Eun Ji Lee, Tae-Woo Kim","doi":"10.1097/IJG.0000000000002528","DOIUrl":null,"url":null,"abstract":"<p><strong>Precis: </strong>While myopia has been recognized as a positive prognostic factor for NTG progression in the adult population, some myopic NTG eyes exhibited significant progression within two years when left untreated, even under low IOP.</p><p><strong>Purpose: </strong>To determine the natural history and risk factors associated with progressive retinal nerve fiber layer (RNFL) thinning in previously stable, treatment-naïve, normal-tension glaucoma (NTG) patients with myopia.</p><p><strong>Methods: </strong>This study included 111 myopic NTG eyes without intraocular pressure (IOP)-lowering treatment for at least 1 year and without disease progression during the treatment-free period. The RNFL thickness was measured and a visual field (VF) test was performed every 6 to 12 months for >2 years. Patients with progressive changes were classified as the P(+) group, while those without progression were classified as the P(-) group. Cox proportional-hazards model assessed risk factors of progression, while linear regression determined factors associated with the rate of RNFL thinning.</p><p><strong>Results: </strong>Progressive change was observed in 25 of the 111 participants [P(+) group, 22.5%]. A family history of glaucoma, higher mean IOP, and maximum IOP during the follow-up were significant factors both for being in the P(+) group and for a faster RNFL thinning. None with a mean IOP <11 mmHg were in the P(+) group. Davies' test identified that 14.2 mmHg was a significant breakpoint (P=0.042), above which the rate of RNFL thinning increased significantly with the mean IOP (R2=0.252, P=0.034).</p><p><strong>Conclusions: </strong>Myopic NTG patients untreated for IOP, especially those with a family history of glaucoma or higher IOP, are at increased risk of progression. Early treatment initiation is advised for high-risk myopic NTG patients, even when their condition appears stable.</p>","PeriodicalId":15938,"journal":{"name":"Journal of Glaucoma","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Glaucoma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/IJG.0000000000002528","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Precis: While myopia has been recognized as a positive prognostic factor for NTG progression in the adult population, some myopic NTG eyes exhibited significant progression within two years when left untreated, even under low IOP.
Purpose: To determine the natural history and risk factors associated with progressive retinal nerve fiber layer (RNFL) thinning in previously stable, treatment-naïve, normal-tension glaucoma (NTG) patients with myopia.
Methods: This study included 111 myopic NTG eyes without intraocular pressure (IOP)-lowering treatment for at least 1 year and without disease progression during the treatment-free period. The RNFL thickness was measured and a visual field (VF) test was performed every 6 to 12 months for >2 years. Patients with progressive changes were classified as the P(+) group, while those without progression were classified as the P(-) group. Cox proportional-hazards model assessed risk factors of progression, while linear regression determined factors associated with the rate of RNFL thinning.
Results: Progressive change was observed in 25 of the 111 participants [P(+) group, 22.5%]. A family history of glaucoma, higher mean IOP, and maximum IOP during the follow-up were significant factors both for being in the P(+) group and for a faster RNFL thinning. None with a mean IOP <11 mmHg were in the P(+) group. Davies' test identified that 14.2 mmHg was a significant breakpoint (P=0.042), above which the rate of RNFL thinning increased significantly with the mean IOP (R2=0.252, P=0.034).
Conclusions: Myopic NTG patients untreated for IOP, especially those with a family history of glaucoma or higher IOP, are at increased risk of progression. Early treatment initiation is advised for high-risk myopic NTG patients, even when their condition appears stable.
期刊介绍:
The Journal of Glaucoma is a peer reviewed journal addressing the spectrum of issues affecting definition, diagnosis, and management of glaucoma and providing a forum for lively and stimulating discussion of clinical, scientific, and socioeconomic factors affecting care of glaucoma patients.