title: Silent cerebral infarct and visual field progression in newly diagnosed normal-tension glaucoma: a cohort study.
abstract: OBJECTIVE
  To investigate whether the presence of silent cerebral infarct (SCI) is related to field progression in patients with newly diagnosed normal-tension glaucoma (NTG).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A total of 286 eyes from 286 NTG patients: 64 with SCI (SCI+) and 222 without SCI (SCI-).
  
  
  METHODS
  Patients were assigned to the SCI+ or SCI- group depending on the presence of SCI as detected by cranial computed tomography scan at baseline. Patients were followed-up at 4-month intervals for 36 months for visual field progression as per Anderson's criteria.
  
  
  METHODS
  The primary outcome was the association between SCI and field progression. Secondary outcomes include the prevalence of SCI in NTG patients and other risk factors associated with progression.
  
  
  RESULTS
  There were no significant differences in the baseline intraocular pressures (IOPs), fluctuation amplitude of pretreatment IOP, baseline visual acuity, vertical cup-to-disc ratio, vertical disc diameter, presenting field indices, and central corneal thickness (CCT) between the 2 groups. Patients with SCI were significantly older compared with SCI- patients (72.4+/-10.7 vs. 63.2+/-14.2 years; P<0.001). Univariate analyses revealed age, fluctuation amplitude of pretreatment IOP, thinner CCT, presence of disc hemorrhage, systemic hypertension, arrhythmia, and SCI were significant for field progression. Silent cerebral infarct was present in 29.6% of field-progressed subjects versus 15.3% of field-stable subjects (P = 0.004). Kaplan-Meier survival analysis revealed that 65.6% of SCI+ versus 45.9% of SCI- patients had progressed (P = 0.003). Cox proportional hazards regression analysis showed disc hemorrhage (hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.54-3.37; P<0.001), SCI (HR, 1.61; 95% CI, 1.09-2.36; P = 0.016), systemic hypertension (HR, 1.48; 95% CI, 1.04-2.10; P = 0.029), and CCT (per 30 mum of thinning; HR, 1.35; 95% CI, 1.16-1.75; P<0.001) were associated with field progression. Other variables significant in the univariate analysis were not significant in the regression model. The most common location of SCI was at the basal ganglia.
  
  
  CONCLUSIONS
  Presence of SCI may be an independent risk factor for visual field progression in patients with NTG.
authors.affiliation: Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong. dexleung@alumni.cuhk.net
authors.forename: Dexter Y L
authors.initials: DY
authors.lastname: Leung
authors.forename: Clement C Y
authors.initials: CC
authors.lastname: Tham
authors.forename: Felix C H
authors.initials: FC
authors.lastname: Li
authors.forename: Yolanda Y Y
authors.initials: YY
authors.lastname: Kwong
authors.forename: Stanley C C
authors.initials: SC
authors.lastname: Chi
authors.forename: Dennis S C
authors.initials: DS
authors.lastname: Lam
mesh_terms: D000368:Aged; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000209:etiology; D015331:Cohort Studies; D018450:Disease Progression; D005130:Eye Hemorrhage / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D006973:Hypertension / Q000150:complications; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology; D009901:Optic Nerve Diseases / Q000150:complications; D011446:Prospective Studies; D012307:Risk Factors; D012607:Scotoma / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed; D014065:Tonometry, Ocular; D058609:Visual Field Tests; D014794:Visual Fields