Objective: The Low- Pressure Glaucoma Treatment Study (LoGTS) seeks to evaluate visual field stability in low- pre- ssure glaucoma patients randomized to intraocular pressure reduction in both eyes with topical twice ...Objective: The Low- Pressure Glaucoma Treatment Study (LoGTS) seeks to evaluate visual field stability in low- pre- ssure glaucoma patients randomized to intraocular pressure reduction in both eyes with topical twice daily brimonidine tartrate 0.2% versus twice daily timolol maleate 0.5% . This article describes the LoGTS design and presents baseline characteristics of the subjects. Design: Randomized, multicenter, double- masked clinical trial. Participants: Low- pressure glaucoma patients 30 years of age or older were identified. Exclusion criteria included an untreated pressure of more than 21 mmHg, advanced visual field loss, and contraindications to study medications. Interventions: Randomization of both eyes to double- masked monotherapy with brimonidine or timolol. Follow- up visits included Humphrey 24- 2 full- threshold perimetry, tonometry every 4 months, and annual optic disc photography. Main Outcome Measure: Progression of visual field loss. Results: One hundred ninety patients were randomized between 1998 and 2000. Mean age (± standard deviation) was 64.9± 10.7 years. Women comprised 59.5% of the patients. Fifty- three patients (27.9% ) had unilateral field loss. The 137 patients with bilateral field loss were older than those with unilateral field loss: 65.7 versus 62.3 years of age (P< 0.05). Mean untreated diurnal intraocular pressures were similar between the eyes of the bilateral patients (mean, 15.5 mmHg in both eyes) and unilateral patients (mean, 16.0 mmHg in field loss vs. 15.6 mmHg in fellow eyes). Visual field mean deviation for all eyes was- 5.4± 4.7 decibels. Central corneal thickness in 168 phakic patients was 543± 35 μ m (range,435- 655 μ m); thickness was less than 500 μ m in 15 eyes and was more than 600 μ m in 11 eyes. Mean vertical cup- to- disc ratio for all eyes was 0.67± 0.15. Unilateral field loss patients had a larger cupto- disc ratio in the field loss eye (0.75± 0.12) than the fello weye with a normal field (0.60± 0.17, P< 0.0001). Disc hemorrhage was present at 展开更多
Purpose. To compare the longitudinal effects of treatment on intraocular pressure (IOP) and visual field performance in Japanese normal tension glaucoma (NTG) between latanoprost and timolol. Pati ents and methods. Th...Purpose. To compare the longitudinal effects of treatment on intraocular pressure (IOP) and visual field performance in Japanese normal tension glaucoma (NTG) between latanoprost and timolol. Pati ents and methods. This is an open label, randomized, study. A total of 62 NTG p atients were prospectively, consecutively enrolled. All study subjects were rand omly assigned to 0.005%latanoprost instillation once daily in the morning or 0. 5%timolol instillation twice daily for a prospective 3 year follow up, and un derwent a routine ocular examination every month. Automated perimetry was perfor med every 6 months using Humphrey field analysers. Stereophotographs of optic di scs were also obtained every 6 months. Results. Percentage of IOP reduction or t he magnitude of IOP reduction showed no intergroup differences either at any tim e point (13-15%). In the visual field, the estimated rate of change in the MD value (dB/year) was-0.34±0.17 (SE) for the latanoprost group, and-0.10±0.18 (SE) for the timolol group. The estimated rate of change in MD showed no signifi cant difference fromzero in both groups, and there were no statistical intergroup differences. No changes in the optic nerve head topography in the vertical cup to disc ratio and rim area measured by imageanalysis techniques were observed in either group. There were no patient s who dropped out due to the side effects of treatment regimens. Conclusion. Bot h latanoprost and timolol single treatments reduced IOP by 13-15%at their trou gh effects for 3 years in Japanese NTG patients; both showed similar effects on visual field performance.展开更多
Purpose: To assess whether baseline retinal nerve fiber layer (RNFL) measurements obtained with a scanning laser polarimeter, the GDx Nerve Fiber Analyzer, (Laser Diagnostic Technologies Inc., San Diego, California) a...Purpose: To assess whether baseline retinal nerve fiber layer (RNFL) measurements obtained with a scanning laser polarimeter, the GDx Nerve Fiber Analyzer, (Laser Diagnostic Technologies Inc., San Diego, California) are predictive of development of repeatable glaucomatous visual field damage in glaucoma suspect eyes. Design: Cohort study. Methods: Participants were recruited from the UCSD longitudinal Diagnostic Innovations in Glaucoma Study (DIGS). One eye from each of 160 glaucoma suspects with normal standard automated perimetry (SAP) visual fields at baseline was studied. Study eyes were divided into convert and nonconvert groups based on the development of three consecutive glaucomatous visual fields during follow- up. SLP parameters, IOP, vertical cup disk ratio, stereophotograph assessment as glaucoma or normal, corneal thickness, and visual field indices were included in univariate and multivariate Cox proportional hazards models to determine which SLP RNFL and ocular parameters were predictive of visual field conversion. Results: Sixteen (10% )- eyes developed repeatable visual field damage (converts) and 144 (90% ) did not (nonconverts). Mean (95% CI) follow- up time until visual field conversion for convert eyes was 2.7 (1.7, 3.6) years. Mean total follow- up of nonconvert eyes was 3.8 (3.5, 4.1) years. Four out of thirteen examined baseline SLP parameters and baseline SAP Mean Deviation (MD), SAP Pattern Standard Deviation (PSD), and glaucomatous stereophotograph assessment were significant univariate predictors of visual field conversion. In multivariate models adjusted for age, IOP and CCT, SLP parameters inferior ratio, ellipse modulation, and UCSD linear discriminant function (LDF)were significant predictors of visual field conversion. When SAP PSD and stereophotograph assessment were also included in the multivariate model inferior ratio and UCSD LDF remained independently predictive of visual field loss. Conclusions: Thinner baseline SLP RNFL measurements were independent predictors of visual fi展开更多
To investigate the relationship between drainage angle configuration with untr eated intraocular pressure (IOP) and optic disc cupping in subjects with chronic angle-closure glaucoma (CACG). Prospective, observational...To investigate the relationship between drainage angle configuration with untr eated intraocular pressure (IOP) and optic disc cupping in subjects with chronic angle-closure glaucoma (CACG). Prospective, observational study. Two hundred s ev-enty-five Asian subjects with CACG who participated in a randomized control led trial that investigated the IOP-reduc-ing effect of latanoprost and timolo l. Chronic angle-closure glaucoma was defined as the presence of glaucomatous o ptic neuropathy (with or without a visual field defect), an anterior chamber ang le in which the pigmented trabecular meshwork was not visible for at least 180° on gonioscopy, and evidence of peripheral anterior synechiae (PAS) in associatio n with elevated IOP of 21 mmHg or more. Static and dynamic gonioscopy were perfo rmed, the angles were graded in each quadrant according to the Shaffer scheme, a nd the number of clock hours of PAS was recorded. The untreated IOP and vertical cup-to-disc ratio were correlated with mean angle width and extent of PAS. Me an angle width, clock hours of PAS, IOP, and vertical cup-to-disc ratio. Most subjects were female (75%), and the mean age was 62.9±9.4 years. The mean angl e width was 0.77±0.53 and the mean number of clock hours of PAS was 4.77±3.2 h ours. Untreated IOP correlated with angle width (r =-0.23; P < 0.001) and clock hours of PAS (r=0.22;P < 0.001). Vertical cup-to-disc ratio also correlated w ith angle width (r=-0.17; P=0.004) and PAS (r=0.28; P < 0.001). Performing a mu ltiple linear regression using baseline IOP as the outcome variable with age, ge nder, clock hours of PAS, and angle width as predictors, there was a 0.39-mmHg (95%confidence interval, 0.15-0.63) increase in baseline untreated IOP for eac h unit increase in clock hours of PAS (P=0.002). In subjects with CACG, the exte nt of PAS and a narrower width of the drainage angle were associated with higher untreated IOP and a larger vertical cup-to-disc ratio.展开更多
Higher baseline pattern standard deviation (PSD) and larger vertical cup to disk ratio (VC/D) were factors in the predictive model for the development of pr imary open angle glaucoma (POAG) in the Ocular Hypertension ...Higher baseline pattern standard deviation (PSD) and larger vertical cup to disk ratio (VC/D) were factors in the predictive model for the development of pr imary open angle glaucoma (POAG) in the Ocular Hypertension Treatment Study. Be cause early changes in PSD and VC/D may be indicative of early POAG damage, we r epeated the prediction model excluding PSD and VC/D. Reanalysis of baseline fact ors for the development of POAG. We compared the hazard ratios for baseline fact ors predictive of POAG in the multivariate Cox proportional hazards model that i ncluded PSD and VC/D and in the model that excluded them. Hazard ratios for base line factors predictive of POAG in Ocular Hypertension Treatment Study were not substantially affected by the inclusion or exclusion of PSD and VC/D in the prop ortional hazards model. Whether PSD or VC/D was included in the Cox proportional hazards model, the same baseline factors were statistically significant and the ir hazard ratios were essentially similar.展开更多
文摘Objective: The Low- Pressure Glaucoma Treatment Study (LoGTS) seeks to evaluate visual field stability in low- pre- ssure glaucoma patients randomized to intraocular pressure reduction in both eyes with topical twice daily brimonidine tartrate 0.2% versus twice daily timolol maleate 0.5% . This article describes the LoGTS design and presents baseline characteristics of the subjects. Design: Randomized, multicenter, double- masked clinical trial. Participants: Low- pressure glaucoma patients 30 years of age or older were identified. Exclusion criteria included an untreated pressure of more than 21 mmHg, advanced visual field loss, and contraindications to study medications. Interventions: Randomization of both eyes to double- masked monotherapy with brimonidine or timolol. Follow- up visits included Humphrey 24- 2 full- threshold perimetry, tonometry every 4 months, and annual optic disc photography. Main Outcome Measure: Progression of visual field loss. Results: One hundred ninety patients were randomized between 1998 and 2000. Mean age (± standard deviation) was 64.9± 10.7 years. Women comprised 59.5% of the patients. Fifty- three patients (27.9% ) had unilateral field loss. The 137 patients with bilateral field loss were older than those with unilateral field loss: 65.7 versus 62.3 years of age (P< 0.05). Mean untreated diurnal intraocular pressures were similar between the eyes of the bilateral patients (mean, 15.5 mmHg in both eyes) and unilateral patients (mean, 16.0 mmHg in field loss vs. 15.6 mmHg in fellow eyes). Visual field mean deviation for all eyes was- 5.4± 4.7 decibels. Central corneal thickness in 168 phakic patients was 543± 35 μ m (range,435- 655 μ m); thickness was less than 500 μ m in 15 eyes and was more than 600 μ m in 11 eyes. Mean vertical cup- to- disc ratio for all eyes was 0.67± 0.15. Unilateral field loss patients had a larger cupto- disc ratio in the field loss eye (0.75± 0.12) than the fello weye with a normal field (0.60± 0.17, P< 0.0001). Disc hemorrhage was present at
文摘Purpose. To compare the longitudinal effects of treatment on intraocular pressure (IOP) and visual field performance in Japanese normal tension glaucoma (NTG) between latanoprost and timolol. Pati ents and methods. This is an open label, randomized, study. A total of 62 NTG p atients were prospectively, consecutively enrolled. All study subjects were rand omly assigned to 0.005%latanoprost instillation once daily in the morning or 0. 5%timolol instillation twice daily for a prospective 3 year follow up, and un derwent a routine ocular examination every month. Automated perimetry was perfor med every 6 months using Humphrey field analysers. Stereophotographs of optic di scs were also obtained every 6 months. Results. Percentage of IOP reduction or t he magnitude of IOP reduction showed no intergroup differences either at any tim e point (13-15%). In the visual field, the estimated rate of change in the MD value (dB/year) was-0.34±0.17 (SE) for the latanoprost group, and-0.10±0.18 (SE) for the timolol group. The estimated rate of change in MD showed no signifi cant difference fromzero in both groups, and there were no statistical intergroup differences. No changes in the optic nerve head topography in the vertical cup to disc ratio and rim area measured by imageanalysis techniques were observed in either group. There were no patient s who dropped out due to the side effects of treatment regimens. Conclusion. Bot h latanoprost and timolol single treatments reduced IOP by 13-15%at their trou gh effects for 3 years in Japanese NTG patients; both showed similar effects on visual field performance.
文摘Purpose: To assess whether baseline retinal nerve fiber layer (RNFL) measurements obtained with a scanning laser polarimeter, the GDx Nerve Fiber Analyzer, (Laser Diagnostic Technologies Inc., San Diego, California) are predictive of development of repeatable glaucomatous visual field damage in glaucoma suspect eyes. Design: Cohort study. Methods: Participants were recruited from the UCSD longitudinal Diagnostic Innovations in Glaucoma Study (DIGS). One eye from each of 160 glaucoma suspects with normal standard automated perimetry (SAP) visual fields at baseline was studied. Study eyes were divided into convert and nonconvert groups based on the development of three consecutive glaucomatous visual fields during follow- up. SLP parameters, IOP, vertical cup disk ratio, stereophotograph assessment as glaucoma or normal, corneal thickness, and visual field indices were included in univariate and multivariate Cox proportional hazards models to determine which SLP RNFL and ocular parameters were predictive of visual field conversion. Results: Sixteen (10% )- eyes developed repeatable visual field damage (converts) and 144 (90% ) did not (nonconverts). Mean (95% CI) follow- up time until visual field conversion for convert eyes was 2.7 (1.7, 3.6) years. Mean total follow- up of nonconvert eyes was 3.8 (3.5, 4.1) years. Four out of thirteen examined baseline SLP parameters and baseline SAP Mean Deviation (MD), SAP Pattern Standard Deviation (PSD), and glaucomatous stereophotograph assessment were significant univariate predictors of visual field conversion. In multivariate models adjusted for age, IOP and CCT, SLP parameters inferior ratio, ellipse modulation, and UCSD linear discriminant function (LDF)were significant predictors of visual field conversion. When SAP PSD and stereophotograph assessment were also included in the multivariate model inferior ratio and UCSD LDF remained independently predictive of visual field loss. Conclusions: Thinner baseline SLP RNFL measurements were independent predictors of visual fi
文摘To investigate the relationship between drainage angle configuration with untr eated intraocular pressure (IOP) and optic disc cupping in subjects with chronic angle-closure glaucoma (CACG). Prospective, observational study. Two hundred s ev-enty-five Asian subjects with CACG who participated in a randomized control led trial that investigated the IOP-reduc-ing effect of latanoprost and timolo l. Chronic angle-closure glaucoma was defined as the presence of glaucomatous o ptic neuropathy (with or without a visual field defect), an anterior chamber ang le in which the pigmented trabecular meshwork was not visible for at least 180° on gonioscopy, and evidence of peripheral anterior synechiae (PAS) in associatio n with elevated IOP of 21 mmHg or more. Static and dynamic gonioscopy were perfo rmed, the angles were graded in each quadrant according to the Shaffer scheme, a nd the number of clock hours of PAS was recorded. The untreated IOP and vertical cup-to-disc ratio were correlated with mean angle width and extent of PAS. Me an angle width, clock hours of PAS, IOP, and vertical cup-to-disc ratio. Most subjects were female (75%), and the mean age was 62.9±9.4 years. The mean angl e width was 0.77±0.53 and the mean number of clock hours of PAS was 4.77±3.2 h ours. Untreated IOP correlated with angle width (r =-0.23; P < 0.001) and clock hours of PAS (r=0.22;P < 0.001). Vertical cup-to-disc ratio also correlated w ith angle width (r=-0.17; P=0.004) and PAS (r=0.28; P < 0.001). Performing a mu ltiple linear regression using baseline IOP as the outcome variable with age, ge nder, clock hours of PAS, and angle width as predictors, there was a 0.39-mmHg (95%confidence interval, 0.15-0.63) increase in baseline untreated IOP for eac h unit increase in clock hours of PAS (P=0.002). In subjects with CACG, the exte nt of PAS and a narrower width of the drainage angle were associated with higher untreated IOP and a larger vertical cup-to-disc ratio.
文摘Higher baseline pattern standard deviation (PSD) and larger vertical cup to disk ratio (VC/D) were factors in the predictive model for the development of pr imary open angle glaucoma (POAG) in the Ocular Hypertension Treatment Study. Be cause early changes in PSD and VC/D may be indicative of early POAG damage, we r epeated the prediction model excluding PSD and VC/D. Reanalysis of baseline fact ors for the development of POAG. We compared the hazard ratios for baseline fact ors predictive of POAG in the multivariate Cox proportional hazards model that i ncluded PSD and VC/D and in the model that excluded them. Hazard ratios for base line factors predictive of POAG in Ocular Hypertension Treatment Study were not substantially affected by the inclusion or exclusion of PSD and VC/D in the prop ortional hazards model. Whether PSD or VC/D was included in the Cox proportional hazards model, the same baseline factors were statistically significant and the ir hazard ratios were essentially similar.
