Effect of Treatment on the Rate of Visual Field Change in the Ocular Hypertension Treatment Study Observation Group (original) (raw)
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Baseline visual field characteristics in the ocular hypertension treatment study
Ophthalmology, 2002
and the Ocular Hypertension Study Group* Purpose: The Ocular Hypertension Treatment Study (OHTS) seeks to evaluate the safety and efficacy of topical ocular hypotensive medication in preventing or delaying the onset of visual field loss and/or optic nerve damage in ocular hypertensive subjects at risk for developing primary open-angle glaucoma. This study evaluates the baseline visual field test characteristics (visual field status, reliability properties, etc.) of patients who underwent eligibility visual field testing for entry to the OHTS.
Long-Term Follow-Up of Ocular Hypertension: A Plea for Peripheral Visual Field Analysis
This case report demonstrates the effect of the peripheral visual field analysis in the management of ocular hypertension (OHT) and early glaucoma. For 17 years, a young Caucasian male with untreated OHT showed no abnormal responses during testing of his central visual field. Five years ago a peripheral visual field test revealed a marked loss beyond the expected age-related changes demonstrating an early peripheral visual field loss of glaucoma. The intraocular pressure was lowered with continuous medication over 5 years, and this leads to an improvement of his peripheral visual field loss. The peripheral Humphrey visual field 60-4 threshold test appears to be a valuable tool to diagnosis early glaucoma in OHT-suspects without apparent central visual field loss. Introduction Ocular hypertension (OHT) is one of the risk factors for glaucoma, but OHT can persist for a long time without leading to glaucomatous damage. Routine checkups are necessary to detect early changes requiring medical therapy to prevent irreversible vision loss. Automated static perimetry (Humphrey Visual Field Analyzer, HVF) was introduced in the 1990's as an early diagnostic and reliable instrument, 1 but due to the time and attention required for performing this test other instruments (e.g. optic nerve head or optic nerve fiber layer analysis) are in favor today. 2 They are based on the common dictum that structural changes in the optic nerve head preceded visual field loss. 3 Lowering the intraocular pressure (IOP) in OHT mitigates the glaucomatous damage in some individuals 4 but long-term treatment can affect the quality of life. 5 It would be best to ascertain if certain individuals with presumed OHT are in fact patients harboring early glaucoma. In a recent study, dramatic changes in the peripheral visual field during aging were described 6 that must be considered when using the peripheral visual field analyzer to determine early glaucomatous damage. 7 This case study demonstrates that both qualitative and quantitative evaluation of the the central and peripheral visual field were necessary to make an early diagnosis of glaucoma in a patient with presumed OHT who was receiving no medical therapy. It is assumed that by using the nasal component of the HVF 60-4, one can define a subgroup of presumed OHT that have early glaucoma and who would benefit from treatment.
Visual Field Improvement in the Collaborative Initial Glaucoma Treatment Study
American Journal of Ophthalmology, 2014
PURPOSE: To evaluate critically visual field (VF) improvement in participants in the Collaborative Initial Glaucoma Treatment Study (CIGTS). DESIGN: Prospective, comparative case series from a randomized clinical trial comparing trabeculectomy and topical medications in treating open-angle glaucoma (OAG).
Ocular Hypertension Treatment Study
Archives of Ophthalmology, 2004
Objective: To report the safety and efficacy of topical ocular hypotensive medication in delaying or preventing the onset of primary open-angle glaucoma (POAG) among African American participants in the Ocular Hypertension Treatment Study.
● PURPOSE: To investigate risk factors associated with visual field progression in the Low-pressure Glaucoma Treatment Study, a prospective trial designed to compare the effects of the alpha2-adrenergic agonist brimonidine tartrate 0.2% to the beta-adrenergic antagonist timolol maleate 0.5% on visual function in low-pressure glau-coma. ● DESIGN: Prospective cohort study. ● METHODS: Low-pressure Glaucoma Treatment Study patients with >5 visual field tests during follow-up were included. Progression was determined using pointwise linear regression analysis, defined as the same 3 or more visual field locations with a slope more negative than 1.0 dB/year at P < 5%, on 3 consecutive tests. Ocular and systemic risk factors were analyzed using Cox proportional hazards model and further tested for independence in a multivariate model. ● RESULTS: A total of 253 eyes of 127 subjects (mean age, 64.7 10.9 years; mean follow-up, 40.6 12 months) were analyzed. Eyes randomized to timolol progressed faster than those randomized to brimonidine (mean rates of progression, 0.38 0.9 vs 0.02 0.7 dB/y, P < .01). In the final multivariate model adjusting for all tested covariates, older age (hazard ratio [HR] 1.41/decade older, 95% confidence interval [CI] 1.05 to 1.90, P .022), use of systemic antihypertensives (HR 2.53, 95% CI 1.32 to 4.87, P .005), and mean ocular perfusion pressure (HR 1.21/mm Hg lower, 95% CI 1.12 to 1.31, P < .001) were associated with progression whereas randomization to brimonidine revealed a protective effect (HR 0.26, 95% CI 0.12 to 0.55, P < .001). ● CONCLUSIONS: While randomization to brimonidine 0.2% was protective compared to timolol 0.5%, lower mean ocular perfusion pressure increased the risk for reaching a progression outcome in the Low-pressure Glaucoma Treatment Study. This suggests that the beneficial effect of randomization to the brimonidine arm was independent of possible differences in ocular perfusion pressures between the 2 treatment arms. The current results and large number of drop-outs in the brimonidine 0.2% arm suggest that more research is necessary before altering clinical practice paradigms. (Am J Ophthalmol 2012;154:702–711.
Baseline mean deviation and rates of visual field change in treated glaucoma patients
Eye, 2011
Purpose To evaluate the relationships between baseline visual field (VF) mean deviation (MD) and subsequent progression in treated glaucoma. Methods Records of patients seen in a glaucoma practice between 1999 and 2009 were reviewed. Patients with glaucomatous optic neuropathy, baseline VF damage, and X8 SITA-standard 24-2 VF were included. Patients were divided into tertiles based upon baseline MD. Automated pointwise linear regression determined global and localized rates (decibels (dB) per year) of change. Progression was defined when two or more adjacent test locations in the same hemifield showed a sensitivity decline at a rate of pÀ1.0 dB per year, Po0.01. Results For mild, moderate, and severe groups, progression was noted in 29.5, 31.2, and 26.0% of eyes (P ¼ 0.50) and global rates of VF change of progressing eyes were À1.3 ± 1.2, À1.01±0.7, and À0.9±0.5 dB/year (P ¼ 0.09, analysis of variance). Within these groups, intraocular pressure (IOP) in stable vs progressing eyes were 15.5±3.3 vs 17.0±3.1 (Po0.01), 15.4 ± 3.3 vs 15.9 ± 2.5 (P ¼ 0.28), and 14.0 ± 2.8 vs 14.8 ± 2.3 mm Hg (P ¼ 0.07). More glaucoma filtering surgeries were performed in eyes with worse MD. There was no significant difference between groups regarding their risk of progression in both univariate (P ¼ 0.50) and multivariate (P ¼ 0.26) analyses adjusting for differences in follow-up IOP.