Korean J Ophthalmol.  2015 Feb;29(1):40-46. 10.3341/kjo.2015.29.1.40.

Comparison of Clinical Characteristics and Progression Rates of Bilaterally and Unilaterally Progressing Glaucoma

• Jeong D
• Sung KR
• Na JH

• KMID: 2360136
• DOI: http://doi.org/10.3341/kjo.2015.29.1.40

Abstract

PURPOSE
To compare the clinical characteristics of unilaterally progressing glaucoma (UPG) and simultaneously bilaterally progressing glaucoma (BPG) in medically treated cases.
METHODS
Primary open angle glaucoma patients were classified as having UPG or BPG according to an assessment of optic disc and retinal nerve fiber layer photographs and visual field analysis. Risk factors including the presence of systemic diseases (hypertension, diabetes, cerebrovascular accident, migraine, and dyslipidema) were compared between the UPG and BPG groups. Baseline characteristics and pre- and post-treatment intraocular pressure (IOP) were compared between the progressing eye (PE) and the non-progressing eye (NPE) within the same patient in the UPG group and between the faster progressing eye and the slower progressing eye in the BPG group.
RESULTS
Among 343 patients (average follow-up period of 4.2 years), 43 were categorized into the UPG group and 31 into the BPG group. The prevalence of all analyzed systemic diseases did not differ between the two groups. PEs in the UPG group had more severe pathology in terms of baseline visual field parameters than NPEs (mean deviation -6.9 ± 5.7 vs. -2.9 ± 3.9 dB, respectively; p < 0.001). However, baseline IOP, mean follow-up IOP, and other clinical characteristics were not significantly different between the PE and the NPE in the UPG group. The progression rate was significantly higher in the faster progressing eye in patients with BPG than in the PE for patients with UPG (-3.43 ± 3.27 vs. -0.70 ± 1.26 dB/yr, respectively; p = 0.014).
CONCLUSIONS
There were no significant differences in the prevalence of systemic diseases between the UPG and BPG groups. Simultaneously bilaterally progressing patients showed much faster progression rates than those with a unilaterally progressing eye.

Keyword

Bilateral; Disease progression; Glaucoma; Unilateral; Visual fields

MeSH Terms

Disease Progression
Female
Follow-Up Studies
Glaucoma, Open-Angle/*diagnosis/physiopathology
Humans
Intraocular Pressure/*physiology
Male
Middle Aged
Optic Disk/*pathology
Retina/*pathology
Retrospective Studies
Time Factors
Visual Fields/*physiology

Figure

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  Fig. 1 The prevalence of progression in all participants.

Reference

1. Ramulu P. Glaucoma and disability: which tasks are affected, and at what stage of disease? Curr Opin Ophthalmol. 2009; 20:92–98.

2. Janz NK, Musch DC, Gillespie BW, et al. Evaluating clinical change and visual function concerns in drivers and nondrivers with glaucoma. Invest Ophthalmol Vis Sci. 2009; 50:1718–1725.

3. Lisboa R, Chun YS, Zangwill LM, et al. Association between rates of binocular visual field loss and vision-related quality of life in patients with glaucoma. JAMA Ophthalmol. 2013; 131:486–494.

4. Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002; 120:701–713.

5. Sommer A, Tielsch JM, Katz J, et al. Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans. The Baltimore Eye Survey. Arch Ophthalmol. 1991; 109:1090–1095.

6. Bonomi L, Marchini G, Marraffa M, et al. Prevalence of glaucoma and intraocular pressure distribution in a defined population. The Egna-Neumarkt Study. Ophthalmology. 1998; 105:209–215.

7. Collaborative Normal-Tension Glaucoma Study Group. The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma. Am J Ophthalmol. 1998; 126:498–505.

8. Leske MC, Heijl A, Hyman L, et al. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology. 2007; 114:1965–1972.

9. Kim CS, Seong GJ, Lee NH, et al. Prevalence of primary open-angle glaucoma in central South Korea the Namil study. Ophthalmology. 2011; 118:1024–1030.

10. Iwase A, Suzuki Y, Araie M, et al. The prevalence of primary open-angle glaucoma in Japanese: the Tajimi Study. Ophthalmology. 2004; 111:1641–1648.

11. Sung KR, Lee S, Park SB, et al. Twenty-four hour ocular perfusion pressure fluctuation and risk of normal-tension glaucoma progression. Invest Ophthalmol Vis Sci. 2009; 50:5266–5274.

12. Berdahl JP, Fautsch MP, Stinnett SS, Allingham RR. Intracranial pressure in primary open angle glaucoma, normal tension glaucoma, and ocular hypertension: a case-control study. Invest Ophthalmol Vis Sci. 2008; 49:5412–5418.

13. Kim C, Kim TW. Comparison of risk factors for bilateral and unilateral eye involvement in normal-tension glaucoma. Invest Ophthalmol Vis Sci. 2009; 50:1215–1220.

14. Drance S, Anderson DR, Schulzer M. Collaborative Normal-Tension Glaucoma Study Group. Risk factors for progression of visual field abnormalities in normal-tension glaucoma. Am J Ophthalmol. 2001; 131:699–708.

15. Sung KR. Disc hemorrhage: is that a risk factor or sign of progression? J Glaucoma. 2012; 21:275–276.

16. Heijl A, Leske MC, Bengtsson B, et al. Measuring visual field progression in the Early Manifest Glaucoma Trial. Acta Ophthalmol Scand. 2003; 81:286–293.

17. Kass MA, Kolker AE, Becker B. Prognostic factors in glaucomatous visual field loss. Arch Ophthalmol. 1976; 94:1274–1276.

18. Susanna R, Drance SM, Douglas GR. The visual prognosis of the fellow eye in uniocular chronic open-angle glaucoma. Br J Ophthalmol. 1978; 62:327–329.

19. Chen PP, Park RJ. Visual field progression in patients with initially unilateral visual field loss from chronic open-angle glaucoma. Ophthalmology. 2000; 107:1688–1692.

20. Suzuki Y, Iwase A, Araie M, et al. Risk factors for open-angle glaucoma in a Japanese population: the Tajimi Study. Ophthalmology. 2006; 113:1613–1617.

21. Casson RJ, Gupta A, Newland HS, et al. Risk factors for primary open-angle glaucoma in a Burmese population: the Meiktila Eye Study. Clin Experiment Ophthalmol. 2007; 35:739–744.

22. Xu L, Wang Y, Wang S, et al. High myopia and glaucoma susceptibility the Beijing Eye Study. Ophthalmology. 2007; 114:216–220.

23. Wong TY, Klein BE, Klein R, et al. Refractive errors, intraocular pressure, and glaucoma in a white population. Ophthalmology. 2003; 110:211–217.

24. Leske MC, Nemesure B, He Q, et al. Patterns of open-angle glaucoma in the Barbados Family Study. Ophthalmology. 2001; 108:1015–1022.

25. Mitchell P, Hourihan F, Sandbach J, Wang JJ. The relationship between glaucoma and myopia: the Blue Mountains Eye Study. Ophthalmology. 1999; 106:2010–2015.

26. Cartwright MJ, Anderson DR. Correlation of asymmetric damage with asymmetric intraocular pressure in normal-tension glaucoma (low-tension glaucoma). Arch Ophthalmol. 1988; 106:898–900.

27. Crichton A, Drance SM, Douglas GR, Schulzer M. Unequal intraocular pressure and its relation to asymmetric visual field defects in low-tension glaucoma. Ophthalmology. 1989; 96:1312–1314.

28. Greenfield DS, Liebmann JM, Ritch R, et al. Visual field and intraocular pressure asymmetry in the low-pressure glaucoma treatment study. Ophthalmology. 2007; 114:460–465.

29. Heijl A, Bengtsson B, Hyman L, et al. Natural history of open-angle glaucoma. Ophthalmology. 2009; 116:2271–2276.

30. Anderson DR, Drance SM, Schulzer M. Collaborative Normal-Tension Glaucoma Study Group. Natural history of normal-tension glaucoma. Ophthalmology. 2001; 108:247–253.