Comparison of the Progression of High- and Low-tension Glaucoma as Determined by Two Different Criteria
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Purpose: To investigate and compare the progression of medically treated primary open angle glaucoma accordingto the baseline intraocular pressure (IOP). Methods: This study included a total of 345 eyes from 345 patients (mean follow-up period, 4.5 years). Eyeswere classified into either conventional normal tension glaucoma (cNTG, ≤21 mmHg) or conventional high-tensionglaucoma (cHTG, >21 mmHg) groups according to the conventional cut-off value of the IOP. Additionally,the median IOP (15 mmHg) was used to create two other groups (median NTG [mNTG] ≤15 mmHg and medianHTG [mHTG] >15 mmHg). Using these values, 306, 39, 153, and 192 eyes were assigned to the cNTG,cHTG, mNTG, and mHTG groups, respectively. Glaucoma progression was determined either by optic disc/retinal nerve fiber layer photographs or serial visual field data. Results: Mean reduction of IOP after medical treatment and of central corneal thickness was lower in the cNTGgroup, while the prevalence of disc hemorrhage and baseline visual field mean deviation did not differ betweenthe cNTG and cHTG groups. A mean reduction in the IOP was observed after medical treatment, and centralcorneal thickness was lower in the mNTG group; disc hemorrhage was more frequent in the mNTG than in themHTG group. Among the 345 analyzed eyes, 100 (29%) showed progression during the follow-up period. Inthe cHTG group, a higher baseline IOP (hazard ratio, 1.147; p = 0.024) was associated with glaucoma progression. Disc hemorrhage (hazard ratio, 15.533; p < 0.001) was also strongly associated with progression in themNTG group. Conclusions: Baseline IOP was a significant risk factor for glaucoma progression in cHTG patients (10% of ourtotal participants), while disc hemorrhage showed the strongest association with progression in the mNTGgroup, indicating that a cut-off value other than the conventional 21 mmHg is required to define true low-tensionglaucoma in populations where NTG predominates among all glaucoma patients.
Abstract
Purpose: To investigate and compare the progression of medically treated primary open angle glaucoma accordingto the baseline intraocular pressure (IOP). Methods: This study included a total of 345 eyes from 345 patients (mean follow-up period, 4.5 years). Eyeswere classified into either conventional normal tension glaucoma (cNTG, ≤21 mmHg) or conventional high-tensionglaucoma (cHTG, >21 mmHg) groups according to the conventional cut-off value of the IOP. Additionally,the median IOP (15 mmHg) was used to create two other groups (median NTG [mNTG] ≤15 mmHg and medianHTG [mHTG] >15 mmHg). Using these values, 306, 39, 153, and 192 eyes were assigned to the cNTG,cHTG, mNTG, and mHTG groups, respectively. Glaucoma progression was determined either by optic disc/retinal nerve fiber layer photographs or serial visual field data. Results: Mean reduction of IOP after medical treatment and of central corneal thickness was lower in the cNTGgroup, while the prevalence of disc hemorrhage and baseline visual field mean deviation did not differ betweenthe cNTG and cHTG groups. A mean reduction in the IOP was observed after medical treatment, and centralcorneal thickness was lower in the mNTG group; disc hemorrhage was more frequent in the mNTG than in themHTG group. Among the 345 analyzed eyes, 100 (29%) showed progression during the follow-up period. Inthe cHTG group, a higher baseline IOP (hazard ratio, 1.147; p = 0.024) was associated with glaucoma progression. Disc hemorrhage (hazard ratio, 15.533; p < 0.001) was also strongly associated with progression in themNTG group. Conclusions: Baseline IOP was a significant risk factor for glaucoma progression in cHTG patients (10% of ourtotal participants), while disc hemorrhage showed the strongest association with progression in the mNTGgroup, indicating that a cut-off value other than the conventional 21 mmHg is required to define true low-tensionglaucoma in populations where NTG predominates among all glaucoma patients.
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