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Association Between Intraocular Pressure Reduction and Progression of Highly Myopic Glaucoma
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- In this study, the authors investigated the association between intraocular pressure (IOP) reduction and glaucoma progression in patients with high myopia (axial length of greater than 26 mm or refraction of less than −6 D). Patients treated for glaucoma showed an average IOP reduction of 17.57 ± 11.94% from baseline; 29.8% of the patients showed both functional and structural glaucoma progression. Patients with a greater percentage of IOP reduction had a higher probability of non-progression than those in the lower tertile of IOP reduction (P = .034). Multivariate analysis demonstrated that the presence of disc hemorrhage was the only factor significantly associated with myopic glaucoma progression (HR, 2.189; P = .032).
- Glaucoma progression in highly myopic eyes may be influenced by the degree of IOP reduction and the presence of disc hemorrhage.
abstract
This abstract is available on the publisher's site.
Access this abstract nowAIMS
To investigate any association between intraocular pressure (IOP) reduction amount and open-angle glaucoma (OAG) progression in highly myopic eyes and to determine the associated risk factors.
METHODS
One hundred and thirty-one (131) eyes of 131 patients with highly myopic OAG, all of whom had received topical medications and been followed for 5 years or longer, were enrolled. Based on the IOP reduction percentage, patients were categorised into tertile groups, and subsequently, the upper-tertile and lower-tertile groups were compared for the cumulative probability of glaucoma progression. Kaplan-Meier survival analysis and log-rank testing were applied in the comparison, and multivariate analysis with Cox's proportional hazard model, additionally, was performed to identify progression risk factors.
RESULTS
Throughout the average 11.6±4.4 year follow-up on the 131 eyes (mean age, 41.2 years at initial visit; baseline IOP, 16.4 mm Hg), 72 eyes (55.0%) showed glaucoma progression. The upper-tertile group (IOP reduction percentage>23.7%) showed a high cumulative probability of non-progression relative to the lower-tertile group (IOP reduction percentage<11.0%; p=0.034), according to the Kaplan-Meier analysis. Presence of disc haemorrhage (DH; HR=2.189; p=0.032) was determined by the multivariate Cox's proportional hazard model to be significantly associated with glaucoma progression. For progressors, the average rate of retinal nerve fibre layer thickness thinning was -0.88±0.74 µm/year, while the MD change was -0.42±0.36 dB/year.
CONCLUSIONS
Glaucoma progression is associated with amount of IOP reduction by topical medications in highly myopic eyes, and DH occurrence is a glaucoma progression risk factor.
Additional Info
Intraocular pressure reduction and progression of highly myopic glaucoma: a 12-year follow-up cohort study
Br J Ophthalmol 2024 Jul 23;108(8)1124-1129, YI Shin, YK Kim, JW Jeoung, KH ParkFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The authors' 12-year retrospective study evaluated data from 131 eyes of 131 patients with open-angle glaucoma (OAG) and high myopia (refraction of less than −6.0 D or axial length of greater than 26 mm) who received treatment "over the course of a follow-up period of not less than 5 years post–OAG diagnosis" to determine risk factors associated with OAG progression. OAG progression was defined as "structural changes to the optic disc and/or retinal nerve fiber layer, or functional changes on visual field tests."
In the progressor group (n = 72), the baseline intraocular pressure (IOP) was 16.56 mm Hg, with a mean IOP during follow-up of 13.41 mm Hg. In the non-progressor group (n = 59), the baseline intraocular pressure was 16.12 mm Hg, with a mean IOP during follow-up of 12.92 mm Hg. The IOP fluctuated during follow-up by 1.84 mm Hg in the progressors and 1.70 mm Hg in the non-progressors. During the study, 60 patients (45.8%) showed functional progression, 51 patients (38.9%) manifested structural progression, and 39 patients (29.8%) showed both structural and functional progression. Of note, "the average time to manifestation of glaucoma progression was 7.70 ± 3.83 years."
Progressors had a significantly higher visual field mean deviation value at the final visit versus non-progressors (−9.54 dB vs −7.46 dB; P = .046). This was statistically significant. The rate of disc hemorrhage (DH) was also "significantly higher among progressors (10 of 72; 13.9%) than among non-progressors (1 of 59; 1.7%; P = .012)." Additionally, the Kaplan–Meier survival analysis showed that eyes that experienced an IOP reduction of >23.3% had a significantly higher rate of non-progression than those that experienced an IOP decrease of <11.1% (P = .034).
Shin et al acknowledged that the limitations of their study were that it was retrospective with a small sample size and that all patients were of Korean ethnicity. Although the authors make a strong case that an IOP reduction of <11.1% and the presence of a DH were significantly more common among progressors, they never disclosed the patients' IOP when they initially presented and were diagnosed and treated for OAG. It has been reported that "normal-tension glaucoma (NTG) is extraordinarily common in Koreans."1 The authors' study should have included a control arm of patients with OAG (baseline IOP, >21 mm Hg) and high myopia since "DH is a significantly negative prognostic factor in patients with NTG."2
The study by Shin et al provides ample evidence that high myopia and DH are prognostic indicators for NTG. Further studies are needed to determine if this is also applicable to patients with OAG and high myopia.
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