Jimin Park,Woo Keun Song,Jooyoung Yoon,Ko Eun Kim,Michael S Kook
{"title":"正常眼压型青光眼患者中心视野快速进展与夜间血压下降。","authors":"Jimin Park,Woo Keun Song,Jooyoung Yoon,Ko Eun Kim,Michael S Kook","doi":"10.1016/j.ajo.2025.09.018","DOIUrl":null,"url":null,"abstract":"PURPOSE\r\nThis study aimed to investigate the relationship between nocturnal blood pressure (BP) dip and rapid central visual field (VF) progression in patients with early-to-moderate stage normal-tension glaucoma (NTG).\r\n\r\nDESIGN\r\nProspective cohort study PARTICIPANTS: : In total, 199 untreated NTG patients participated in this study.\r\n\r\nMETHODS\r\nIn total, 199 untreated NTG patients underwent 24-h ambulatory BP monitoring (ABPM) in their habitual position, with a minimum 2-year follow-up. Patients were classified as non-dippers, dippers, and over-dippers based on their nocturnal BP dip. The rates of central VF changes over time among these groups were compared using linear mixed model analysis. Fast central VF progression was defined as a decline in the mean total deviation (MTD10) values of 12 central points at a rate of < -0.5 dB/year. Logistic regression analysis identified clinical factors, including nocturnal BP dip, that contribute to accelerated central VF progression.\r\n\r\nMAIN OUTCOME MEASURES\r\nRate of central VF progression and prevalence of fast central VF progression RESULTS: : Over-dippers showed a significantly faster rate of central VF progression than non-dippers and dippers, as indicated by the MTD10 decline over an average follow-up of 4.9 years (non-dippers: -0.23 dB/year; dippers: -0.27 dB/year; over-dippers: -0.53 dB/year; P = 0.007). The prevalence of fast central VF progression was significantly higher in over-dippers (non-dippers: 19.8%; dippers: 23.5%; over-dippers: 60.0%; P < 0.001). A higher percentage of nocturnal mean arterial pressure (MAP) dip was identified as a significant risk factor for fast central VF progression (odds ratio: 1.062, P < 0.05).\r\n\r\nCONCLUSIONS\r\nPatients with NTG classified as over-dippers showed significantly faster central VF progression than non-dippers and dippers, with over 50% of over-dippers experiencing fast progression. Rapid central VF progression was significantly associated with the percentage of nocturnal MAP dip in eyes with early-to-moderate stage NTG. These findings highlight the importance of closely monitoring central VF changes in NTG patients with pronounced nocturnal BP dips to prevent functional impairment caused by rapid central VF loss.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"2 1","pages":""},"PeriodicalIF":4.2000,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Fast Central Visual Field Progression in Patients with Normal-Tension Glaucoma and Nocturnal Blood Pressure Dip.\",\"authors\":\"Jimin Park,Woo Keun Song,Jooyoung Yoon,Ko Eun Kim,Michael S Kook\",\"doi\":\"10.1016/j.ajo.2025.09.018\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"PURPOSE\\r\\nThis study aimed to investigate the relationship between nocturnal blood pressure (BP) dip and rapid central visual field (VF) progression in patients with early-to-moderate stage normal-tension glaucoma (NTG).\\r\\n\\r\\nDESIGN\\r\\nProspective cohort study PARTICIPANTS: : In total, 199 untreated NTG patients participated in this study.\\r\\n\\r\\nMETHODS\\r\\nIn total, 199 untreated NTG patients underwent 24-h ambulatory BP monitoring (ABPM) in their habitual position, with a minimum 2-year follow-up. Patients were classified as non-dippers, dippers, and over-dippers based on their nocturnal BP dip. The rates of central VF changes over time among these groups were compared using linear mixed model analysis. Fast central VF progression was defined as a decline in the mean total deviation (MTD10) values of 12 central points at a rate of < -0.5 dB/year. Logistic regression analysis identified clinical factors, including nocturnal BP dip, that contribute to accelerated central VF progression.\\r\\n\\r\\nMAIN OUTCOME MEASURES\\r\\nRate of central VF progression and prevalence of fast central VF progression RESULTS: : Over-dippers showed a significantly faster rate of central VF progression than non-dippers and dippers, as indicated by the MTD10 decline over an average follow-up of 4.9 years (non-dippers: -0.23 dB/year; dippers: -0.27 dB/year; over-dippers: -0.53 dB/year; P = 0.007). The prevalence of fast central VF progression was significantly higher in over-dippers (non-dippers: 19.8%; dippers: 23.5%; over-dippers: 60.0%; P < 0.001). A higher percentage of nocturnal mean arterial pressure (MAP) dip was identified as a significant risk factor for fast central VF progression (odds ratio: 1.062, P < 0.05).\\r\\n\\r\\nCONCLUSIONS\\r\\nPatients with NTG classified as over-dippers showed significantly faster central VF progression than non-dippers and dippers, with over 50% of over-dippers experiencing fast progression. Rapid central VF progression was significantly associated with the percentage of nocturnal MAP dip in eyes with early-to-moderate stage NTG. These findings highlight the importance of closely monitoring central VF changes in NTG patients with pronounced nocturnal BP dips to prevent functional impairment caused by rapid central VF loss.\",\"PeriodicalId\":7568,\"journal\":{\"name\":\"American Journal of Ophthalmology\",\"volume\":\"2 1\",\"pages\":\"\"},\"PeriodicalIF\":4.2000,\"publicationDate\":\"2025-09-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Ophthalmology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ajo.2025.09.018\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ajo.2025.09.018","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
Fast Central Visual Field Progression in Patients with Normal-Tension Glaucoma and Nocturnal Blood Pressure Dip.
PURPOSE
This study aimed to investigate the relationship between nocturnal blood pressure (BP) dip and rapid central visual field (VF) progression in patients with early-to-moderate stage normal-tension glaucoma (NTG).
DESIGN
Prospective cohort study PARTICIPANTS: : In total, 199 untreated NTG patients participated in this study.
METHODS
In total, 199 untreated NTG patients underwent 24-h ambulatory BP monitoring (ABPM) in their habitual position, with a minimum 2-year follow-up. Patients were classified as non-dippers, dippers, and over-dippers based on their nocturnal BP dip. The rates of central VF changes over time among these groups were compared using linear mixed model analysis. Fast central VF progression was defined as a decline in the mean total deviation (MTD10) values of 12 central points at a rate of < -0.5 dB/year. Logistic regression analysis identified clinical factors, including nocturnal BP dip, that contribute to accelerated central VF progression.
MAIN OUTCOME MEASURES
Rate of central VF progression and prevalence of fast central VF progression RESULTS: : Over-dippers showed a significantly faster rate of central VF progression than non-dippers and dippers, as indicated by the MTD10 decline over an average follow-up of 4.9 years (non-dippers: -0.23 dB/year; dippers: -0.27 dB/year; over-dippers: -0.53 dB/year; P = 0.007). The prevalence of fast central VF progression was significantly higher in over-dippers (non-dippers: 19.8%; dippers: 23.5%; over-dippers: 60.0%; P < 0.001). A higher percentage of nocturnal mean arterial pressure (MAP) dip was identified as a significant risk factor for fast central VF progression (odds ratio: 1.062, P < 0.05).
CONCLUSIONS
Patients with NTG classified as over-dippers showed significantly faster central VF progression than non-dippers and dippers, with over 50% of over-dippers experiencing fast progression. Rapid central VF progression was significantly associated with the percentage of nocturnal MAP dip in eyes with early-to-moderate stage NTG. These findings highlight the importance of closely monitoring central VF changes in NTG patients with pronounced nocturnal BP dips to prevent functional impairment caused by rapid central VF loss.
期刊介绍:
The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect.
The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports.
Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.