It
is well known that some glaucoma patients tend to progress more rapidly
compared to other patients, even though the diagnostic parameters in the two
groups such as C:D ratio, and IOP are similar.
On
visual field (VF) analysis rapidly progressive disease is defined as a decline
in MD of greater than or equal to 1 dB/year. This is regarded as significant as
it can lead to progression of the disease from early to advanced stage in just
10-15 years.
Usually,
glaucoma patients have an average rate of progression between -0.3 and -0.5 dB
decline in mean deviation (MD) per year.
Chan
et al, have compared 48 rapidly progressing eyes (progression ‡1 dB mean
deviation [MD]/year) with 486 non–rapidly progressing eyes (progression <1 dB
MD/year).
The
objective of their study was to determine the intraocular and systemic risk
factor differences between a cohort of rapid glaucoma disease progressors and
nonrapid disease progressors.
- The study found that rapid progressors were older, and had significantly lower central corneal thickness (CCT). These patients also had lower baseline intraocular pressure (IOP), and a significantly worse baseline MD compared with nonrapid progressors.
- The rapid progressors were more likely to have pseudoexfoliation syndrome, disc hemorrhages, changes in ocular medications, and glaucoma surgery.
- These patients had significantly higher rates of cardiovascular disease and hypotension. Subjects with cardiovascular disease were 2.33 times more likely to develop rapidly progressive glaucoma disease despite significantly lower mean and baseline IOPs.
The
mean rate of progression for rapid progressors was -1.55 dB/year, while for
nonrapid progressors it was -0.24 dB/year.
Average IOP and
IOP fluctuation were not significantly different between rapid progressors and
nonrapid progressors. Reported rates of hypertension, diabetes mellitus, migraines,
vasospasm, steroid use, and high myopia were also not significantly different
between the 2 groups.
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