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Relationship between mean follow-up intraocular pressure, rates of visual field progression and current target intraocular pressure guidelines
  1. Bruna Melchior1,2,
  2. Carlos Gustavo De Moraes1,
  3. Jayter S Paula2,
  4. George A Cioffi1,
  5. Christopher A Girkin3,
  6. Massimo A Fazio3,
  7. Robert N Weinreb4,
  8. Linda M Zangwill4,
  9. Jeffrey M Liebmann1
  1. 1 Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
  2. 2 Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
  3. 3 Department of Ophthalmology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
  4. 4 Hamilton Glaucoma Center, Department of Ophthalmology, University of California San-Diego, La Jolla, California, USA
  1. Correspondence to C. Gustavo De Moraes, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165th Street, Box 69, New York, NY 10032, USA; demoraesmd{at}gmail.com

Abstract

Aims To investigate if eyes presenting intraocular pressure (IOP) within the limits of current guideline-driven target IOP indeed experience slow rates of glaucomatous visual field (VF) progression.

Methods A total of 8598 24-2 VF tests from 603 eyes from the African Descent and Glaucoma Evaluation Study with manifest glaucoma were included. The sample was split into three groups based on baseline VF mean deviation (MD): G1 (better than −5.0 dB), G2 (−5.0 to −10 dB) and G3 (worse than −10 dB). We investigated the relationship between existing target IOP guidelines and rates of MD progression in these groups.

Results For stable eyes, the medians and IQR of the mean follow-up IOP were G1=15.0 mmHg (IQR: 13.1 to 17.7), G2=13.2 mmHg (IQR: 11.6 to 14.3) and G3=11.9 mmHg (IQR: 10.1 to 13.8) (p<0.01). When considering the mean follow-up IOP within the limits proposed by current guidelines, the median MD slopes were: −0.20 dB/y (IQR: −0.43 to −0.02) for G1<21 mmHg, −0.19 dB/y (IQR: −0.51 to −0.01) for G2<18 mmHg and −0.15 dB/y (IQR: −0.47 to 0.05) for G3<15 mmHg (p=0.63). There were no significant differences between racial groups.

Conclusion In a sample of patients with manifest glaucoma, despite substantial variability between eyes, adherence to treatment guidelines helped slow the rates of global VF progression at various stages of disease.

Trial registration number clinicaltrials.gov Identifier: NCT00221923.

  • Glaucoma
  • Intraocular pressure
  • Vision
  • Field of vision
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Footnotes

  • Contributors BM and CGDM designed the study. BM and CGDM analysed and interpreted the data. BM, CGDM and JML wrote the initial draft. JSP, GAC, CAG, MAF, RNW and LMZ revised the manuscript. CGDM and JML supervised the study. All authors provided a final review and approved the manuscript before submission.

  • Funding National Eye Institute Grants U10EY14267, EY08208, EY11008, EY019869, EY13959, 1EY027510, EY025253 (CGDM) – Bethesda, MD; Eyesight Foundation of Alabama – Birmingham, AL; Alcon Laboratories Inc. – Fort Worth, TX; Allergan Inc. – Dublin, Ireland; Pfizer Inc. – New York, NY; Merck Inc. – Rahway, NJ; Santen Inc. – Osaka, Japan; unrestricted departmental grant from Research to Prevent Blindness, New York, NY (Department of Ophthalmology, Columbia University Medical Center and Department of Ophthalmology, University of California San Diego), Edith C. Blum Foundation, New York, NY, Bernard Schwartz Travel Grant from the American Glaucoma Society, San Francisco, CA. The sponsor or funding organisations had no role in the design or conduct of this research. Most of the grants have no number.

  • Financial disclosures BMS: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasília, Brazil. CGDM: Consultant: Belite – San Diego, CA; Reichert – Buffalo, NY; Novartis – East Hanover, NJ; Galimedix Therapeutics Inc. – Kensington, MD; Carl Zeiss Meditec Inc. – Dublin, CA; Perfuse Therapeutics – San Francisco, CA; Recipient: Heidelberg Engineering GmbH – Heidelberg, Germany; Topcon Medical Systems – Oakland, NJ. JSP: Consultant: Allergan, Inc. – Dublin, Ireland. GAC: No financial disclosures. CAG: Financial support: Research to Prevent Blindness, New York, NY; Heidelberg Engineering GmbH – Heidelberg, Germany; National Eye Institute – Bethesda, MD; Eyesight Foundation of Alabama – Birmingham, AL. MAF: National Eye Institute – Bethesda, MD; EyeSight Foundation of Alabama, AL; Research to Prevent Blindness – New York NY; Heidelberg Engineering GmbH – Heidelberg, Germany. RNW: Consultant: Aerie Pharmaceuticals – Pittsburgh, PA; Allergan Inc – Dublin, Ireland; Bausch healthcare, Inc. – Bridgewater, NJ; Eyenovia – New York NY; Financial support: Heidelberg Engineering GmbH – Heidelberg, Germany; Carl Zeiss Meditec Inc. – Dublin, CA; Centervue – Fremont, CA; Konan Medical – Irvine, CA; Optovue Inc. – Fremont, CA; Bausch healthcare, Inc. – Bridgewater, NJ. Patent: Toromedes, Inc. – La Jolla, CA; Carl Zeiss Meditec Inc. – Dublin, CA. LMZ: Financial support: − Carl Zeiss Meditec Inc. – Dublin, CA; Heidelberg Engineering GmbH – Heidelberg, Germany; Optovue Inc. – Fremont, CA; Topcon Medical Systems – Oakland, NJ; National Eye Institute – Bethesda, MD; Recipient: Heidelberg Engineering GmbH – Heidelberg, Germany. Patent: Carl Zeiss Meditec Inc. – Dublin, CA. JML: Consultant: Aerie Pharmaceuticals, Inc. – Pittsburgh, PA; Eyenovia – New York NY; Heidelberg Engineering, GmBH – Heidelberg, Germany; NY;– Laval, Canada; Novartis – East Hanover, NJ; Galimedix Therapeutics Inc. – Kensington, MD; Bausch healthcare, Inc. – Bridgewater, NJ; Allergan, Inc. – Dublin, Ireland. Financial Support: Heidelberg Engineering, GmBH – Heidelberg, Germany; National Eye Institute – Bethesda, MD; Research to Prevent Blindness, New York, NY.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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