The association between glaucomatous visual fields and optic nerve head features in the Ocular Hypertension Treatment Study.
OBJECTIVE
To determine the association between change from baseline in the optic nerve head (ONH) and the visual field (VF) during follow-up of ocular hypertension participants in the Ocular Hypertension Treatment Study.


METHODS
Longitudinal randomized clinical trial.


METHODS
One hundred sixty-eight eyes of 152 ocular hypertensive participants ages 40 to 80 years.


METHODS
Cox hazard models were applied to 3232 eyes, which included 81 eyes that reached a study end point by developing a glaucomatous VF (VF end point) and 128 eyes that reached a study end point by developing an optic disc change (optic disc end point).


METHODS
Primary open-angle glaucoma end point as determined by changes in the VF or optic disc.


RESULTS
Forty-one eyes reached an end point by both VF and optic disc criteria; 40 eyes reached only a VF end point, and 87 reached only an optic disc end point. Times to reach isolated disc or field end points were similar. Visual field end points were more likely (P<0.0001) in eyes that showed the following ONH features: an ONH hemorrhage, thinning of the optic disc rim, or enlargement of the horizontal cup-to-disc (C/D) ratio. Optic disc end points were more likely (P<0.0001) in eyes that showed the following VF features: some evidence of a nasal step or a partial arcuate VF defect, or an increase in the pattern standard deviation (PSD).


CONCLUSIONS
Both the VF and the optic disc must be monitored with equal diligence, because either may show the first evidence of glaucomatous damage. Changes in the ONH based on stereophotographic observation (rim thinning, hemorrhage, or a slight increase in C/D ratio) and VF changes (evidence of a nasal step/partial arcuate defect or an increase in PSD) suggest that these cases have an increased risk of developing glaucoma. Confirmation of such subtle findings should be sought through repeat testing and correlation with other clinical results.
Keltner
John L
JL
Department of Ophthalmology and Visual Science, University of California, Davis, Sacramento, California 95817, USA. jlkeltner@ucdavis.edu
Johnson
Chris A
CA
Anderson
Douglas R
DR
Levine
Richard A
RA
Fan
Juanjuan
J
Cello
Kimberly E
KE
Quigley
Harry A
HA
Budenz
Donald L
DL
Parrish
Richard K
RK
Kass
Michael A
MA
Gordon
Mae O
MO
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007429:Intraocular Pressure; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis / Q000188:drug therapy; D009898:Optic Disk / Q000473:pathology*; D010781:Photography; D016016:Proportional Hazards Models; D014786:Vision Disorders / Q000175:diagnosis*; D014792:Visual Acuity; D058609:Visual Field Tests; D014794:Visual Fields
D000959:Antihypertensive Agents