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Non-Morphological Risk Factors for Progressive Glaucomatous Optic Nerve Head Changes in Normal Pressure Glaucoma

1Rabethge S., 2Martus P., 1Budde W. M.,
1Ruprecht-Karls-Universität Heidelberg, Fakultät für klinische Medizin Mannheim, Augenklinik (Mannheim)
2Freie Universität Berlin, Klinikum Benjamin Franklin, Institut für Medizinische Informatik, Biometrie und Epidemiologie (Berlin)

Purpose: To evaluate which parameters besides morphologic features of the optic disc are risk factors for progressive optic nerve head changes in normal-pressure glaucoma.
Method: The prospective clinical observational study included 94 eyes of 60 Caucasian patients with normal-pressure glaucoma. All patients underwent repeated qualitative and morphometric evaluation of color stereo optic disc photographs. Progression of glaucoma was defined as loss of neuroretinal rim or presence of optic disc hemorrhages. Mean follow-up time was 23.78 ± 15.92 months. Statistical dependency of left and right eye from the same subject was adjusted for.
Results: Progression of glaucomatous optic nerve changes was detected in 63 eyes (63/94=67.0%). At baseline of the study, mean minimal intraocular pressure readings were marginally significantly higher and visual field loss variance was marginally significantly more progressed (0.05 < p < 0.10) in the progressive group compared with the unchanged group. The group of eyes with eventual progression and the group of eyes without progression did not vary significantly in refractive error, mean maximal intraocular pressure, and frequencies of diabetes mellitus, arterial hypertension, and a positive family history of glaucoma (p>0.10).
Conclusions: Non-morphologic risk factors for progression of the glaucomatous appearance of the optic nerve head in patients with normal-pressure glaucoma may possibly be the minimal intraocular pressure measurements. Presence of diabetes mellitus, arterial hypertension and a positive family history (?) of glaucoma may not be major risk factors for the progression of normal-pressure glaucoma.