Original Articles
Intraocular pressure and progression of glaucomatous visual field loss

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Abstract

PURPOSE:

To evaluate the relationship between intraocular pressure and visual field progression in patients with primary open-angle glaucoma.

METHODS:

We prospectively followed 113 patients with early to moderate glaucomatous field damage. Conventional automated static perimetry, high-pass resolution perimetry, and intraocular pressure measurements were carried out at 6-month intervals. The mean and the highest intraocular pressure in the follow-up were compared in stable and progressing patients with each perimetric technique.

RESULTS:

The mean (± SD) follow-up was 4.5 ± 0.9 years. The mean (± SD) intraocular pressure in patients remaining stable with conventional perimetry [18.2 ± 3.3 mm Hg, n = 81 (71.7%)] was not significantly different (P =.65) from those in whom it progressed (17.9 ± 3.3 mm Hg, n = 32 [28.3%]). The mean intraocular pressure in patients remaining stable with high-pass resolution perimetry (17.9 ± 3.5 mm Hg, n = 63 [55.8%]) was not significantly different (P = .33) from those in whom it progressed (18.5 ± 3.0 mm Hg, n = 50 [44.2%]). The mean (± SD) of the highest (single or three highest) pressure during follow-up for stable and progressing patients with conventional perimetry was not significantly different (22.6 ± 5.0 and 23.0 ± 4.6 mm Hg, respectively, P = .76). However, for high-pass resolution perimetry, the difference was highly significant (21.6 ± 4.5 and 24.1 ± 4.9 mm Hg, respectively, P < .01). Furthermore, patients who progressed with high-pass resolution perimetry had more damaged baseline fields compared with those who remained stable (P < .01).

CONCLUSIONS:

The mean level of intraocular pressure does not differentiate glaucoma patients with progressive visual field loss from ones who remained stable. Baseline visual field status and peak intraocular pressure of patients who progress with high-pass resolution perimetry are significantly different from those who remain stable.

Section snippets

Patients and methods

patients with glaucoma who met the inclusion and exclusion criteria (Table 1)were recruited on a consecutive basis from the practice of one of us (R.P.L.) and from the Eye Care Centre of the Queen Elizabeth II Health Sciences Centre. This study was approved by the Queen Elizabeth II Health Sciences Centre Ethics Committee. The nature of the procedures was fully explained to each subject.

All patients first underwent a complete ophthalmologic examination. When both eyes of one patient were

Results

The study population consisted of 113 eyes of 113 patients, of whom 55 were men and 58 were women. The mean (± SD) age at the beginning of the study was 61.4 ± 13.1 years (range, 17 to 89 years). The patients were followed for a mean (± SD) period of 4.6 ± 0.9 years (range, 2 to 6 years). The mean (± SD) number of visual field examinations (conventional and high-pass resolution perimetry) and intraocular pressure measurements was 10.1 ± 2.4 (range, 5 to 13). The distribution of the number of

Discussion

Our study showed that progression of visual field damage in glaucoma, determined by conventional and high-pass resolution perimetry, occurs over a wide distribution of intraocular pressure values. We could not find significant differences in the mean intraocular pressure during the follow-up between stable and progressing glaucoma patients using either perimetric technique.

Some patients in our study had visual field progression with either technique with mean intraocular pressure levels as low

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    This study was supported by grant MT-11357 from the Medical Research Council of Canada, Ottawa, Ontario, Canada.

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