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. 2021 Sep 1;30(9):759-768.
doi: 10.1097/IJG.0000000000001906.

The Association Between Intraocular Pressure and Visual Field Worsening in Treated Glaucoma Patients

Jithin Yohannan  1 , Michael V Boland, Pradeep Ramulu
Affiliations

The Association Between Intraocular Pressure and Visual Field Worsening in Treated Glaucoma Patients

Jithin Yohannan et al. J Glaucoma. .

Abstract

Precis: In treated eyes with mild/suspect glaucoma, intraocular pressure (IOP) increments are associated with worsening mean deviation (MD) once IOP reaches the 20s. In moderate/advanced eyes, IOP increments are associated with worse visual field (VF) performance across the entire IOP range.

Purpose: The purpose of this study was to describe the relationship between mean treated IOP and VF worsening and understand how this relationship is affected by glaucoma severity and IOP range.

Methods: A total of 1446 eyes of 869 treated glaucoma patients with at least 5 longitudinal reliable VF tests and IOP measures were included. Mixed-effects linear models were employed to understand the effect of eye-specific mean treated IOP on MD slope. Models included interaction terms to assess the differing relationships between MD slope and mean IOP by glaucoma severity (suspect/mild vs. moderate/advanced) and splines to account for the differing effects of mean IOP on MD slope at different IOP ranges (above or below 21 mm Hg).

Results: In suspect/mild glaucoma, when treated IOP values were <21 mm Hg, a 1 mm Hg increment in IOP was not associated with an increase in the rate of VF worsening (P>0.05) but when treated IOP values rose >21 mm Hg, a 1 mm Hg increment in IOP was associated with faster VF worsening (-0.09 dB/y per 1 mm Hg increment, P<0.05). In moderate/advanced disease, a 1 mm Hg increment in treated IOP was associated with faster VF worsening both below and above 21 mm Hg, but the effect was much more pronounced in the higher range (-0.02 dB/y per mm Hg increment <21 mm Hg vs. -0.74 dB/y per mm Hg increment >21 mm Hg, P<0.05 for both).

Conclusion: IOP remained associated with VF worsening in eyes with more advanced glaucoma throughout the IOP range but was only associated with VF worsening in eyes with less severe glaucoma at higher IOP.

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Conflict of interest statement

Disclosure: M.V.B. is a consultant for Carl Zeiss Meditec. The remaining authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Density Plot of Mean Deviation Change Over Time by Disease Stage
Figure 2.
Figure 2.
Density Plots of Mean, Maximum and Standard Deviation of Intraocular Pressure by Disease Stage
Figure 3.
Figure 3.
Effect of Mean, Maximum and Standard Deviation of Intraocular Pressure on Visual Field Mean Deviation Slope
Figure 4.
Figure 4.
Effect of Mean, Maximum and Standard Deviation of Intraocular Pressure on Proportion of Eyes with Visual Field Worsening (Worsening Defined as Mean Deviation Slope <−0.5 dB/year).
See this image and copyright information in PMC

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