Clinical factors associated with progression of glaucomatous optic disc damage in treated patients

Arch Ophthalmol. 2001 Jun;119(6):813-8. doi: 10.1001/archopht.119.6.813.


Background: Reducing intraocular pressure (IOP) in glaucomatous eyes does not always prevent disease progression.

Objective: To determine the clinical factors associated with progressive optic disc damage in glaucomatous eyes receiving treatment to reduce IOP.

Methods: Baseline and follow-up optic disc photographs as well as demographic and clinical data were retrospectively studied in 186 eyes of 93 patients with primary open-angle glaucoma, and in 138 eyes of 69 patients with normal-pressure glaucoma. The patients with primary open-angle glaucoma were included in the study only if their treated IOPs during a follow-up period of 5 years were less than 21 mm Hg. The patients with normal-pressure glaucoma were included only if their IOPs were reduced by at least 20% during the follow-up period. The association of progressive optic disc damage with patient- and eye-specific characteristics was examined using multivariate analysis.

Results: During the 5-year study period, 141 (43.5%) of the 324 eyes exhibited progressive optic disc damage defined by at least a 5% decrease in the neural rim area-to-disc area ratio. Using multivariate analysis, the following were found to be strongly associated with progressive neural rim damage: a baseline smaller neural rim area-disc area ratio (P<.001); a baseline larger zone beta area-disc area ratio (P =.04); a baseline larger parapapillary atrophy length-disc circumference ratio (P =.05); a diagnosis of normal-pressure glaucoma (P =.01); and combined medical and surgical treatment prior to the study period (P =.01).

Conclusions: Clinical factors other than IOP may be important indicators of subsequent progression of glaucomatous optic disc damage. Our findings suggest that eyes with advanced glaucomatous optic disc damage and normal-pressure glaucoma are more likely to progress despite receiving treatment to reduce IOP.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Glaucoma, Open-Angle / physiopathology*
  • Glaucoma, Open-Angle / therapy*
  • Humans
  • Intraocular Pressure
  • Male
  • Multivariate Analysis
  • Odds Ratio
  • Optic Disk / physiopathology*
  • Optic Nerve Diseases / physiopathology*
  • Photography
  • Retrospective Studies