Association of blood and ocular perfusion pressure with structural glaucomatous progression by flicker chronoscopy.
BACKGROUND
Vascular risk factors have been associated with glaucomatous visual field progression.


OBJECTIVE
We determined the relationship between vascular risk factors and structural glaucomatous progression using serial flicker chronoscopy images.


METHODS
Two glaucoma fellowship-trained ophthalmologists, masked to temporal sequence, independently graded serial flicker chronoscopy images from one eye of a cohort of glaucoma patients for features of structural progression in this retrospective cohort study. After adjudication, simple and multiple logistic models were constructed to determine variables associated with increased odds of progression, including systolic blood pressure (BP), diastolic BP and mean ocular perfusion pressure.


RESULTS
Seventy-two eyes of 72 patients were analysed. Patients with any form of structural progression (n=40) were older (67.0 vs 58.8 years; p=0.005) and had lower diastolic BP (71.8 vs 76.5 mm Hg; p=0.02) than patients without progression (n=32). In the univariable model, diastolic BP was associated with progressive retinal nerve fibre layer (RNFL) loss (OR=0.2 per 10 mm Hg, 95% CI 0.1 to 0.6, p<0.006) and neuroretinal rim loss (OR=0.4 per 10 mm Hg, 95% CI 0.2 to 0.8, p<0.01). Diastolic BP was also significant in the multivariable model for RNFL loss (p=0.009) and neuroretinal rim loss (p=0.003).


CONCLUSIONS
This study is the first to use structural progression and flicker chronoscopy to identify vascular glaucoma risk factors. Older age and lower diastolic BP were associated with progression. By multivariable analysis diastolic BP was associated with RNFL and neuroretinal rim loss. These findings suggest that diastolic BP is associated with structural glaucomatous progression which may have implications for management.
Department of Ophthalmology, Weill Cornell Medical College, , New York, NY, USA.
Margaret M
MM
McGlynn
Joshua R
JR
Ehrlich
Elizabeth D
ED
Marlow
Ru-Ik
RI
Chee
Fabiana Q
FQ
Silva
Sarah H
SH
Van Tassel
Nathan M
NM
Radcliffe
D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D007429:Intraocular Pressure / Q000502:physiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009898:Optic Disk / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D014065:Tonometry, Ocular; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology
Glaucoma; Imaging