Elsevier

Ophthalmology

Volume 111, Issue 11, November 2004, Pages 2126-2132
Ophthalmology

Original article
Central corneal pachymetry and visual field progression in patients with open-angle glaucoma

https://doi.org/10.1016/j.ophtha.2004.04.029Get rights and content

Abstract

Purpose

To investigate the association between corneal pachymetry and visual field progression in patients with chronic open-angle glaucoma.

Design

Retrospective case–control study.

Participants

Eighty-eight patients with primary open-angle glaucoma, pseudoexfoliative glaucoma, pigmentary glaucoma, or normal-tension glaucoma, followed for an average of 8 years, who had visual field loss and progression as defined by modified Anderson criteria. Cases with progression were matched for race, diagnosis, and age at pachymetry with controls who did not have progression.

Methods

Progression was defined by use of the modified Anderson criteria. Central corneal thickness (CCT) was determined by ultrasound pachymetry.

Main outcome measures

Visual field progression and corneal pachymetry.

Results

The mean CCT in patients with visual field progression was significantly lower than the mean CCT in patients who did not progress (529±36 μm vs. 547±35 μm; P = 0.02). Those with thinner CCT were more likely to progress than those with thicker CCT as identified by Cox proportional hazards regression analysis (P = 0.01; hazard ratio, 1.44 for a 40-μm thinner CCT; 95% confidence interval, 1.12–1.80), and CCT was the only risk factor identified to be significantly associated with visual field progression.

Conclusions

In this case–control patient population, visual field progression in patients with open-angle glaucoma was significantly associated with thinner CCT.

Section snippets

Patients and methods

The Human Subjects Division of the University of Washington approved this retrospective study. All patients were selected from a database of patients seen between April and November 2000, which served as the basis of a previous report.21 All patients who met the following inclusion criteria were enrolled in this study: (1) at least 2 years of follow-up with Humphrey visual fields; (2) the patient demonstrated visual field progression with criteria modified from Anderson and described below; (3)

Results

Forty-four eyes of 44 patients met inclusion criteria and were matched with 44 eyes of 44 control subjects. Demographic data and initial characteristics are listed in Table 1. The diagnosis of glaucoma was made in 3 patients between 1975 and 1980, in 4 patients between 1981 to 1985, in 14 patients between 1986 and 1990, and in 24 patients after 1990. There was no significant difference between the subjects and the matched control group in age at diagnosis, age at pachymetry, follow-up time,

Discussion

In our study of the association of CCT and visual field progression in patients with OAG, we found that those eyes with progression had a thinner mean CCT than those who did not progress (529 vs. 547 μm; P = 0.02) (Table 1). Thinner CCT was significantly associated with progression in the multivariate analysis also (Cox regression, P = 0.02). We found a HR of 1.44 per 40 μm thinner CCT (95% CI, 1.12–1.80).

To place this figure in perspective, for a 40-μm decrease in CCT, the OHTS found a

References (57)

  • R.C. Wolfs et al.

    Distribution of central corneal thickness and its association with intraocular pressurethe Rotterdam Study

    Am J Ophthalmol

    (1997)
  • M. Korey et al.

    Central corneal endothelial cell density and central corneal thickness in ocular hypertension and primary open-angle glaucoma

    Am J Ophthalmol

    (1982)
  • P.J. Foster et al.

    Central corneal thickness and intraocular pressure in a Mongolian population

    Ophthalmology

    (1998)
  • K. Inoue et al.

    Morphological study of corneal endothelium and corneal thickness in pseudoexfoliation syndrome

    Jpn J Ophthalmol

    (2003)
  • L.L. Wu et al.

    Central corneal thickness of normal tension glaucoma patients in Japan

    Jpn J Ophthalmol

    (2000)
  • R.A. Hill et al.

    Molteno implantation for glaucoma in young patients

    Ophthalmology

    (1991)
  • M.A. Lloyd et al.

    Clinical experience with the single-plate Molteno implant in complicated glaucomasupdate of a pilot study

    Ophthalmology

    (1992)
  • A. Behndig et al.

    Transient corneal edema after phacoemulsificationcomparison of 3 viscoelastic regimens

    J Cataract Refract Surg

    (2002)
  • M.M. Whitacre et al.

    The effect of corneal thickness on applanation tonometry

    Am J Ophthalmol

    (1993)
  • R. Ritch et al.

    Exfoliation syndrome

    Surv Ophthalmol

    (2001)
  • H. Goldmann et al.

    Über Applanationstonometrie

    Ophthalmologica

    (1957)
  • M.R. Wilson et al.

    Epidemiology of chronic open-angle glaucoma

  • R.P. Copt et al.

    Corneal thickness in ocular hypertension, primary open-angle glaucoma, and normal tension glaucoma

    Arch Ophthalmol

    (1999)
  • B.Y. Emara et al.

    Central corneal thickness in low-tension glaucoma

    Can J Ophthalmol

    (1999)
  • N. Ehlers et al.

    Central corneal thickness in low-tension glaucoma

    Acta Ophthalmol (Copenh)

    (1974)
  • M.O. Gordon et al.

    The Ocular Hypertension Treatment Studybaseline factors that predict the onset of primary open-angle glaucoma

    Arch Ophthalmol

    (2002)
  • D.C. Herman et al.

    Increased corneal thickness in patients with ocular hypertension

    Arch Ophthalmol

    (2001)
  • A.C. Ventura et al.

    Central corneal thickness measurements in patients with normal tension glaucoma, primary open angle glaucoma, pseudoexfoliation glaucoma, or ocular hypertension

    Br J Ophthalmol

    (2001)
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    Manuscript no. 240046.

    Supported in part by an unrestricted departmental grant from Research to Prevent Blindness, Inc., New York, New York.

    The authors have no financial or proprietary interest in any product mentioned within this article.

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