Morphology of the optic papilla in glaucoma. I. Primary open-angle glaucoma

BACKGROUND: Previous studies have shown that the chronic open-angle glaucomas form a heterogeneous spectrum of diseases which have in common an open anterior chamber angle and glaucomatous optic nerve damage. Purpose of this study was to evaluate whether the appearance of the optic disc differs among the various types of primary open-angle glaucoma. METHODS: Color stereo optic disc photographs of 683 patients with primary open-angle glaucoma (POAG), and 481 normal eyes were morphometrically evaluated. RESULTS: Morphologic characteristics of the glaucoma types were as follows: Highly myopic POAG: secondary macrodiscs with abnormal shape; shallow, flat, concentric disc cupping; low frequency of disc hemorrhages; large parapapillary atrophy or myopic crescent; medium to low intraocular pressure. Juvenile-onset POAG: Optic disc of normal size and shape; deep and steep disc cupping; low frequency of broad rim notches or large disc hemorrhages; small parapapillary atrophy; high minimal and maximal intraocular pressure measurements. Age-related atrophic POAG: Optic disc of normal size and shape; shallow, flat and concentric disc cupping; medium to low frequency of disc hemorrhages; large parapapillary atrophy; medium to low intraocular pressure. Eyes with normal-pressure glaucoma: Optic disc of normal size and shape; deep and steep cupping; relatively small parapapillary atrophy; high frequency of disc hemorrhages and rim notches. CONCLUSIONS: These characteristics in the appearance of the optic disc may be helpful for clinical diagnosis and therapy and may give pathogenetic hints.     

The effect of the intraocular pressure reduction on glaucomatous disc changes and visual field defects]

The authors prospectively studied changes in the optic disc and visual field associated with intraocular pressure (IOP) reduction for one year after surgery in 12 primary open-angle glaucoma eyes of 7 patients who underwent trabeculectomy because of elevated IOP despite maximum tolerable medical therapy and whose cup volume was demonstrated to be decreased at 3 or 6 months after surgery. Topographic parameters including C/D ratio, rim area and cup volume were determined by the Optic Nerve Head Analyzer plus (Rodenstock). The 30-2 central threshold field was obtained with a Humphrey Field Analyzer at the same time. Mean deviation (MD), corrected pattern standard deviation (CPSD) and total deviation (TD) were used to evaluate visual field changes. Significant improvement of C/D ratio, rim area and cup volume and significant IOP reduction were noted at 1 year after surgery as compared with preoperative baseline value (p less than 0.01). Also the MD was significantly decreased at 1 year after surgery, compared with the preoperative baseline value (p less than 0.05). There was a significant negative correlation between the preoperative MD and the percent change of the MD at 1 year after surgery (r = -0.80, p less than 0.01). Our results suggest that the decrease of optic disc cupping can persist over one year after surgery and that the early visual field defects in glaucoma eyes can gradually improve in association with the decrease of cupping.     

Visual field global indices in patients with reversal of glaucomatous cupping after intraocular pressure reduction

The authors investigated visual field changes in 28 eyes of 28 adult patients with early-to-moderate chronic open-angle glaucoma (COAG) in whom reversal of glaucomatous disc cupping was documented by computerized image analysis (Rodenstock Optic Nerve Head Analyzer) after intraocular pressure (IOP) reduction from 29.3 (+/- 5.9) to 19.4 (+/- 4.3) mmHg over 34.8 (+/- 24.8) weeks. Humphrey Statpac global indices (mean deviation and pattern standard deviation) improved in direct proportion to the magnitude of IOP reduction even after controlling for the possible influences of learning effect, short-term fluctuation, reliability, duration of IOP reduction, age, and pupil size. The mean visual field global indices (mean deviation and pattern standard deviation) improved in patients with IOP reduction of 40% or greater, in statistically significant contrast to no improvement of mean global indices with IOP reduction less than 35%. The beneficial effect of IOP reduction is apparent in COAG patients with topographical evidence of reversal of cupping.     

Effect of topical glaucoma medications on optic disc topography in normal tension glaucoma

PURPOSE: To investigate the effects of topical glaucoma medications on optic disc topography in patients with normal tension glaucoma (NTG) using confocal scanning laser ophthalmoscopy. SUBJECTS AND METHODS: We enrolled 39 NTG patients (39 eyes) who had not been treated for glaucoma. A combined medication of 0.005% latanoprost and 0.5% timolol gel was administered. Optic disc parameters were measured before and after the treatment using the Heidelberg Retina Tomograph (HRT). The treatment period was 20.2 +/- 6.4 days (mean +/- SD). RESULTS: Administration of these two drugs significantly decreased the intraocular pressure (IOP) from 16.7 +/- 1.9 mmHg to 12.3 +/- 1.9 mmHg (26.7 +/- 8.7% decrease). Cup area, cup/disk area ratio and cup volume decreased significantly, while the rim area increased significantly. Linear progression analysis showed a significant correlation between the percent decrease in the IOP and the topographic changes in the cup area, cup/disk area ratio, rim area, cup volume, rim volume, and height variation contour. When the subjects were divided into two groups: patients with high baseline IOP of more than 16 mmHg (HNTG group) and those with low baseline IOP below 15 mmHg (LNTG group), significant changes in several parameters were observed only in the HNTG group. CONCLUSIONS: These results suggest that the topographic changes in the optic disc were induced by the short-term topical glaucoma medications prescribed for the NTG patients, and the changes in several HRT parameters correlated with the percent decrease in the IOP.     

Elevated intraocular pressure associated with steroid treatment for infantile spasms

PURPOSE: To evaluate the ocular changes and medical and surgical therapy after high-dose systemic steroid treatment in babies with infantile spasm and hypsarrhythmia. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: In 5 of the 9 (55%) babies with infantile spasm exposed to systemic corticosteroid treatment, an increase in intraocular pressure (IOP) and optic disc cupping was observed. INTERVENTION: Ophthalmic examination under mild sedation was conducted 3 to 4 weeks after initiation of systemic therapy. Antiglaucoma treatment was given to the patients found to have high IOPs and cup-to-disc ratio changes. Routine follow-up was continued until systemic therapy was completed. MAIN OUTCOME MEASURES: Controlled IOP with a decrease in cupping damage after antiglaucoma therapy. RESULTS: Five patients required antiglaucoma treatment; one also underwent augmented trabeculectomy. Mean IOP decreased in this subgroup from 30.1 +/- 9.5 mmHg to 15.4 +/- 4.2 mmHg in the right eye (P = 0.043) and from 32.6 +/- 7.4 mmHg to 15.2 +/- 1.8 mmHg in the left eye (P = 0.043). Mean cup-to-disc ratio improved from 0.53 +/- 0.2 to 0.37 +/- 0.04 in the right eye (P = 0.06) and from 0.57 +/- 0.12 to 0.35 +/- 0.05 in the left eye (P = 0.042). CONCLUSIONS: The rapid onset of IOP and cup-to-disc ratio changes in patients with infantile spasm and hypsarrhythmia treated by high-dose corticosteroids necessitates early and intensive monitoring to prevent anatomic ocular damage and visual impairment in the future.     

Relationship between optic disc cupping change and intraocular pressure control in adult glaucoma patients

• Background: Until recently, there has been a paucity of quantitative evidence for intraocular pressure (IOP)-dependent optic disc cupping change in adult glaucoma patients. Therefore, we investigated the relationship between optic disc cupping change and IOP control. • Methods: The study involved 78 eyes of 78 randomly selected adult patients with early to moderate chronic open-angle glaucoma (COAG), treated on various therapeutic regimens, who had had two consecutive successful optic disc analyses with the Rodenstock Optic Nerve Head Analyzer 15.8 ± 14.8 weeks apart. • Results: The mean initial IOP of 27 eyes (34%) with cupping reversal did not differ from that of 17 eyes (22%) demonstrating progressive deterioration (29.2 ± 8.8 vs 26.2 ± 6.1 mmHg,P > 0.5), but the reversal group did have a significantly greater mean IOP decrease than the progression group (−10.8 ± 7.9 vs −1.0 ± 7.7 mmHg,P < 0.001) and significantly lower mean final IOP (18.3 ± 6.1 vs 25.2 ± 7.9 mmHg,P < 0.003). • Conclusion: A decrease of optic disc cupping is more likely with a greater IOP reduction and a lower final IOP, and an increase of cupping is more likely with less or no IOP reduction and a higher final IOP. Part of the content was presented as a paper of PAAO at the 1991 Joint Annual Meeting of the AAO/PAAO, Anaheim, California The authors have no proprietary interest in the Rodenstock Optic Nerve Head Analyzer     

Switching to latanoprost monotherapy for 24 weeks in glaucoma patients

PURPOSE: To investigate the intraocular pressure lowering effect in glaucoma patients switched to latanoprost therapy from isopropyl unoprostone given as monotherapy or in combination with a beta-blocker. METHODS: Patients with primary open angle glaucoma or normal tension glaucoma treated with 0.12% isopropyl unoprostone as monotherapy or in combination with a beta-blocker were eligible for this single-center clinical study. Of the 51 patients (51 eyes) enrolled, 18 were men and 33 were women aged 62.1 +/- 12.3 years (mean +/- SD). Twenty-two patients had primary open angle glaucoma, and 29 patients had normal tension glaucoma. Intraocular pressure was measured twice within 3 months prior to the switch, and the mean value was taken as the baseline. The patients were then switched to latanoprost (0.005%) monotherapy (once-daily administration), and changes in intraocular pressure were monitored. One physician measured intraocular pressure after 4, 8, 16, and 24 weeks of administration in this 24-week study. RESULTS: The mean intraocular pressures were 16.0 +/- 2.4 mmHg at baseline, 13.7 +/- 2.3 mmHg after 4 weeks, 13.1 +/- 2.1 mmHg after 8 weeks, 13.6 +/- 2.0 mmHg after 16 weeks, and 13.3 +/- 2.4 mmHg after 24 weeks. A significant decrease in intraocular pressure was noted at all time points in both groups (paired t-test, p < 0.0001), and the intraocular pressure lowering effect persisted through week 24 of administration (analysis of variance, p < 0.0001). CONCLUSIONS: Switching to latanoprost monotherapy elicits further reduction in intraocular pressure in patients with primary open angle glaucoma or normal tension glaucoma.     

Measurements of reversibility of optic disc cupping in glaucoma using a computerized videographic image analyzer

Optic disc changes were studied in young and elderly glaucoma patients who underwent reduction of intraocular pressure (IOP) by filtrating surgery. A computerized videographic image analysis system (Optic Nerve Head Analyzer, Rodenstock) was used to measure the cup/disc-ratio, the ratio of the rim area over the disc area (rim area/disc area-ratio), and the ratio of the cup volume over the disc area (cup volume/disc area-ratio) before and after filtrating surgery. Each parameter was assessed as total and quadrantal values. Materials consisted of 19 eyes of 15 patients (8 eyes of 5 patients with primary open angle glaucoma, 2 eyes of 2 patients with secondary glaucoma, and 9 eyes of 7 patients with developmental glaucoma). Sixteen eyes (84%) of 12 patients showed a decrease of the total cup/disc-ratio after operation. In this group, the patients had a decrease in IOP of 18.9 +/- 10. 6mmHg (mean +/- SD) after the operation. Among 16 eyes that had a decreased total cup/disc-ratio, statistically significant decrease of the cup/disc-ratio (p less than 0.01) and statistically significant increase of the rim area/disc area-ratio (p less than 0.01) were noted in total and for all quadrants except for the temporal. The greatest improvement of cupping was seen in the nasal quadrant. With regard to cup volume/disc area-ratio, a statistically significant decrease was observed in total and in all quadrants (p less than 0.01). The IOP change correlated linearly with that of the total cup volume/disc area-ratio (R = 0.51, p less than 0.05). No statistically significant linear correlation was noted between age and the change in any disc parameter.     

Changes in optic disc parameters after intraocular pressure reduction in adult glaucoma patients.

PURPOSE: To quantitatively evaluate the change in the optic disc topographic parameters associated with reduction in the intraocular pressure (IOP) after trabeculectomy in adult patients with glaucoma. METHODS: A series of 22 patients (mean age: 45.7+/-15.1 years) with several types of glaucoma were examined for various parameters of optic disc before and after trabeculectomy. Cup area, cup-to-disc area ratio, cup volume, rim volume, mean cup depth, and maximum cup depth were determined by means of laser scanning tomography (LST), and the parameters were correlated with the degree of postsurgical IOP decrease. RESULTS: The IOP in adult glaucoma patients showed significant reductions after trabeculectomy. The values for all topographic parameters examined. except cup volume, showed statistically significant postsurgical changes as compared to the presurgical values. Of all postsurgical changes in parameters. the increase in the rim volume was the most noticeable; it was remarkably evident in those eyes with postsurgical IOP levels less than 15 mm Hg. It was also demonstrated that the anterior displacement of the glaucomatous cupping may occur after surgery. CONCLUSIONS: It is obvious that optic disc parameters can change after IOP reduction after successful surgery in adult glaucoma patients as well as in infantile glaucoma patients. The site of changeable glaucomatous optic cupping is topographically variable among patients and it may be related to the presurgical shape of the optic cup.     

Reversal of optic disc cupping after trabeculotomy in primary congenital glaucoma

BACKGROUND: The phenomenon of reversal of glaucomatous cupping of the optic disc following lowering of the intraocular pressure (IOP) was originally recognized in infants. We evaluated the change in optic disc cupping with normalization of the IOP after trabeculotomy in primary congenital glaucoma and assessed the factors associated with reversal of cupping. METHODS: We reviewed the records of 17 patients (24 eyes) who underwent trabeculotomy between July 1993 and June 1999 and who had been followed for at least 1 year. Surgical success was defined as IOP less than 22 mm Hg without anti-glaucoma medication, stable or reduced optic disc cupping, and lack of further corneal enlargement disproportionate to normal growth. Patients who required more than one surgical procedure to control the IOP and those with cloudy media that precluded documentation of cupping were excluded from analysis. Optic disc cupping was assessed independently before and after surgery by two clinicians. The cup:disc ratio was estimated as the percentage of surface area of the optic disc occupied by cupping in the vertical axis. We accepted a difference of 0.1 or 0.2 in the cup:disc ratio between the two observers in each subjective assessment and used the mean value of the two results for data analysis. If the difference was more than 0.2, the eye was excluded from further study. RESULTS: Of the 17 patients 4 were excluded: 2 because they received antiglaucoma medication to control the IOP postoperatively, 1 because he underwent more than one surgical procedure to control the IOP during follow-up, and 1 owing to disagreement in the assessment of the cup:disc ratio between the two observers. Eighteen eyes of 13 patients were thus included in the analysis. Twelve eyes were from boys and six, from girls. The patients were followed for a mean of 43.2 (standard deviation [SD] 30.4) months (range 12 to 90 months). The mean cup:disc ratios pre- and postoperatively were 0.74 (SD 0.20) and 0.60 (SD 0.21) respectively (p = 0.003). Of the 18 eyes 11 (61.1%) had documented reduction in optic disc cupping. The mean time to stabilization of cupping reversal was 4.8 (SD 2.8) months (range 2 to 12 months). In multivariable analysis the age of the patient at surgery was the only variable significantly associated with reversal of cupping (p = 0.027). The mean age at surgery for the 11 eyes with reduction in cupping was 6.9 (range 3 to 15) months, compared with 23.4 (range 12 to 42) months for the 7 eyes with unchanged cupping. The mean preoperative cup:disc ratio was 0.67 (SD 0.17) in the former group and 0.83 (SD 0.17) in the latter group. Six of the seven eyes with unchanged cupping had advanced cupping. INTERPRETATION: Optic disc cupping can be reversed at an early stage of primary congenital glaucoma following successful reduction of IOP. Younger age at surgery was associated with reversal of cupping.     

颅内压下降所致眼颅压力梯度增大对视盘血流密度影响的临床研究

目的探讨颅内压(ICP)下降所致眼颅压力梯度(TLPD)增大与视盘血流密度改变的相关关系。 方法前瞻性病例对照研究。收集2018年9月至2018年12月北京同仁医院神经内科行腰椎穿刺(LP)收集脑脊液后ICP降低的患者20例(26只眼)为实验组。其中,男性8例(12只眼),女性12例(14只眼);年龄23~61岁,平均年龄(41.7±2.8)岁;收集健康志愿者13例(26只眼)为对照组。其中,男性5例(10只眼),女性8例(16只眼);年龄21~62岁,年龄(46.9±2.7)岁。检测实验组患者的眼内压(IOP)、ICP、脑脊液压力(CSFP)、TLPD、眼灌注压(OPP)及血压;检测对照组健康志愿者的IOP、OPP及血压;根据CSFP计算ICP下降程度(CSFP)。实验组,根据CSFP分为亚组A(15 mmH₂O2O,6只眼)、亚组B(30 mmH₂O2O,5只眼)及亚组C(CSFP >45 mmH₂O,15只眼)等三个亚组。实验组患者记录脑脊液初压与末压,并于LP前和LP后15 min进行眼底相干光层析血管成像(OCTA)检查,测量视盘区血流密度;对照组,检查其在与LP患者相同体位改变前后的视盘区血流密度。应用配对t检验分别评估两组组内IOP、血压、OPP及视盘区血流密度变化情况和实验组各亚组内视盘区血流密度在不同程度ICP改变后的变化情况。 结果对照组在体位改变后IOP、OPP、视盘区及各象限血流密度均未发现明显改变,差异无统计学意义(t＝0.061,-0.361;P>0.05)。实验组LP后ICP由(11.8±2.2)mmHg下降至(7.8±2.0)mmHg,差异有统计学意义(t＝13.061,P<0.05);TLPD由(5.2±3.2)mmHg升高至(9.3±2.9)mmHg,差异有统计学意义(t＝-8.621, P<0.05);视盘内、视盘周及视盘周毛细血管血流密度均明显下降,差异有统计学意义(t＝2.502, 3.848, 3.389;P<0.05)。在ICP下降超过45 mmH₂O时,视盘周平均血流密度及视盘周毛细血管血流密度改变最明显,差异有统计学意义(t＝4.043, 4.332;P<0.05)。 结论ICP下降所致的TLPD增大可导致视盘区血供减少,同时引起视盘周毛细血管微循环障碍,ICP下降程度越大,视盘区微循环异常越显著。     

Effects of short term increase of intraocular pressure on optic disc cupping

AIMS—To evaluate the effect of acute elevation of intraocular pressure (IOP) on optic disc cupping.
METHODS—10 emmetropic and 10 myopic volunteers were included in this study. The cup area (CA) and cup volume (CV) of the optic disc were determined with the Heidelberg retina tomograph (HRT). After baseline determinations, a suction cup was used to increase the intraocular pressure (IOP) to 20-25 mm Hg above the baseline and HRT images were obtained.
RESULTS—Baseline IOP was 13.5 (SD 1.3) mm Hg and 12.6 (2.6) mm Hg in the emmetropic and myopic groups, respectively. The IOP was elevated to 35.4 (3.3) mm Hg and 34.4 (2.5) mm Hg in the emmetropic and myopic groups, respectively. When compared with their baseline values, the cupping variables (CA and CV) were significantly increased (p<0.05) during the suction treatment in both emmetropic and myopic subjects.
CONCLUSION—There was a significant enlargement in the optic disc cupping during the artificial increment of intraocular pressure in both emmetropic and myopic eyes. In non-glaucomatous eyes the optic nerve head has a partially dynamic topography dependent upon the level of IOP.

Keywords: optic disc; intraocular pressure; compliance; glaucoma     

Optic disc and retinal nerve fiber layer analysis with scanning laser tomography after LASIK

PURPOSE: To examine whether LASIK induces changes in the optic disc and retinal nerve fiber layer using scanning laser tomography. METHODS: Prospective, consecutive study of 53 myopic eyes in 38 patients (mean age: 35.7 +/- 10.4 years; range: 22 to 58 years). Preoperative average refractive error was -6.0 +/- 2.4 diopters (D) (spherical equivalent) (range: -2.0 to -10.0 D). Optic disc morphology and retinal nerve fiber layer thickness were evaluated with scanning laser tomography preoperatively and at 7 and 13 months postoperatively. RESULTS: No statistically significant differences were noted between the pre- and postoperative optic disc and retinal nerve fiber layer measurements. CONCLUSIONS: Our results suggest that transient extreme elevation of intraocular pressure during LASIK does not affect the optic disc morphology or retinal nerve fiber layer thickness in normal myopic eyes for at least 1 year after surgery.     

Optic disc size in ocular hypertension

PURPOSE: To study the optic disc size in eyes with ocular hypertension (OHT) in comparison to primary open-angle glaucoma (POAG) and normals. METHODS: Optic disc photographs obtained with the Nidek 3dx NM camera were digitized (Nikon coolscan) and disc area calculated using Littmann correction in a randomly chosen eye of 28 OHT, 42 POAG and 30 normal subjects. OHT was defined as increased intraocular pressure with no disc or field changes suggestive of glaucoma with open angles. RESULTS: The optic disc area in OHT was 9.47 +/- 1.09 mm2; 12.27 +/- 2.87 mm2 in POAG; and 12.11 +/- 2.83 mm2 in normal individuals. CONCLUSION: Using magnification corrected morphometry and the criteria for OHT diagnosis, the optic disc area in OHT was significantly smaller (p < 0.0001) in POAG and normals.     

Intraocular pressure-related pattern of optic disc cupping in adult glaucoma patients

The pattern of glaucomatous optic disc cupping was investigated in 67 eyes of 67 primary open-angle glaucoma patients with early-to-moderate visual field loss and a wide range of intraocular pressure. We determined the position of the deepest point of the optic disc cup using the Rodenstock Analyzer. This position correlated significantly with intraocular pressure: the deepest point tended to be located below the center of the optic disc at high intraocular pressure and above the center at low intraocular pressure. There was no significant correlation between the position of the deepest cup point along the horizontal axis and intraocular pressure. The position of the deepest point of the cup also correlated significantly with the severity of glaucoma, albeit less strongly than with intraocular pressure: it tended to be in the inferior portion of the disc at an early stage of glaucoma and in the superior portion of the disc at a more advanced stage of glaucoma. Therefore, the inferior portion of the optic nerve head appears to be most yielding to changes of intraocular pressure. These findings are consistent with histologic evidence of the least connective tissue support in the inferoperipheral region of the lamina cribrosa and with greater prevalence of inferior rim loss and corresponding superior visual field defects in early to moderately advanced primary open-angle glaucoma patients.Presented in part at the annual meeting of the Association for Research in Vision and Ophthalmology, Sarasota, Florida, 28 April–3 May 1991; the authors have no proprietary interest in the Rodenstock Optic Nerve Head Analyzer Correspondence to: D.H. Shin     

Laser in situ keratomileusis-induced optic neuropathy

OBJECTIVE: To report a case of bilateral optic neuropathy after bilateral laser-assisted in situ keratomileusis (LASIK) surgery. DESIGN: Observational case report. METHODS: Complete eye examination with detailed evaluation of the optic nerve, detailed medical history, stereo disc photographs, GDx Nerve Fiber Analyzer testing, Humphrey 24-2 SITA visual field testing, diurnal intraocular pressure measurement, serologic evaluation, and magnetic resonance imaging of the brain and orbits. MAIN OUTCOME MEASURES: Optic nerve status, visual field status, and visual acuity. RESULTS: A subject with previously healthy optic nerves had bilateral optic neuropathy develop after LASIK surgery. This neuropathy manifested with a subjective decrease in visual field, normal visual acuity, normal color vision, relative afferent pupillary defect, increased cupping of the optic nerve with focal neuroretinal rim defects, decreased nerve fiber layer thickness, and nerve fiber bundle-type visual field defects. The subject had no other risk factors for optic neuropathy. No other cause of neuropathy was identified. CONCLUSIONS: Optic neuropathy is a potential vision-threatening complication of LASIK surgery. This complication may be due to barotrauma or ischemia related to extreme elevation of intraocular pressure by the suction ring. Careful examination of the optic nerve before and after LASIK surgery is warranted.     

Laser trabeculoplasty versus medication treatment as primary therapy for glaucoma

The first-year results of a 5-year prospective randomized follow-up study on 39 glaucoma patients, of whom 19 patients received laser trabeculoplasty and 20 patients medication therapy as primary treatment of their newly detected open-angle glaucoma, are presented. The optic disc changes were recorded by measuring the magnification corrected neuroretinal rim area from stereoscopic optic disc photographs and the visual field changes with an automated perimeter. There were no statistically significant differences in success rate, intraocular pressure reduction, and optic disc or visual field changes between the two groups during the first year of follow-up. In half of the laser treated patients the intraocular pressure was below 22 mmHg without medication treatment. Many patients in the medication group required frequent modifications of their therapy. Laser trabeculoplasty has an important role as primary therapy in glaucoma.     

Early diagnosis of glaucoma. II. The value of the initial examination in ocular hypertension

In a group of 46 patients with moderately elevated intraocular pressure (22-30 mmHg), signs of early glaucoma were found in half of them after a follow-up of 5-7.5 years. Most of the patients showed only a small increase in optic disc cupping revealed by stereophotography. Initial IOP higher than 25 mmHg, large pressure differences between the two eyes, large diurnal pressure variation, occurrence of pseudoexfoliation, pressure drop of more than 8 mmHg after topical epinephrine, and a pressure rise of more than 4 mmHg after water loading were more frequent in the group of patients who developed signs of glaucoma. Age, a positive family history, occurrence of cardiovascular disease, and the cup/disc ratio did not differ in the two groups of patients. The pilocarpine test and steroid provocation had no predictive value. Surprisingly, there was a small drop of pressure after topical steroids in 6 of the 8 patients with pseudoexfoliation.     

The European glaucoma prevention study design and baseline description of the participants

OBJECTIVES: The European Glaucoma Prevention Study seeks to evaluate the efficacy of reducing intraocular pressure (IOP), with dorzolamide to prevent or delay patients affected by ocular hypertension from developing primary open-angle glaucoma. DESIGN: Randomized, double-blinded, controlled clinical trial. PARTICIPANTS: Patients (age > or =30 years) were enrolled from 18 European centers. The patients fulfilled a series of inclusion criteria including the measurements of IOP (22-29 mmHg), two normal and reliable visual fields (VFs) (on the basis of mean defect and corrected pattern standard deviation/corrected loss of variance of standard 30/II Humphrey or Octopus perimetry), and normal optic disc as determined by the Optic Disc Reading Center (vertical and horizontal cup-to-disc ratios; asymmetry between the two eyes < or =0.4). INTERVENTION: Patients were randomized to the treatment with dorzolamide or a placebo. MAIN OUTCOME MEASURES: End points are VF and/or optic disc changes. A VF change during the follow-up must be confirmed by two further positive tests. Optic disc change is defined by the agreement of two out of three independent observers evaluating optic disc stereo-slides. RESULTS: One thousand seventy-seven subjects were randomized between January 1, 1997 and May 31, 1999. The mean age was 57.03 +/- 10.3 years; 54.41% were women and 99.9% were Caucasian. Mean IOP was 23.6 +/- 1.6 mmHg in both eyes. Mean visual acuity was 0.97 +/- 0.11 in both eyes; mean refraction was 0.23 +/- 1.76 diopters in the right eye and 0.18 +/- 1.79 diopters in the left eye. Previous use of medication for ocular hypertension was reported by 38.4% of the patients, systemic hypertension by 28.1%, cardiovascular diseases by 12.9%, and diabetes mellitus by 4.7%. The qualifying VFs were normal and reliable according to protocol criteria. CONCLUSIONS: The mean IOP of the patients enrolled in the European Glaucoma Prevention Study is consistent with the estimated mean IOP (within the range of 22-29 mmHg) found in a large sample of the European population. The European Glaucoma Prevention Study should be able to better address the clinical question of whether pharmacological reduction of IOP (by means of dorzolamide) in ocular hypertension patients at moderate risk for developing primary open-angle glaucoma effectively lowers the incidence of primary open-angle glaucoma.