GRANT'S SYNDROME

Grant's syndrome is a rare cause of secondary glaucoma.The syndrome was first described, and named, by Chandler and Grant in 1968. So far, only 16 primary cases have been reported. Two other cases have occurred after argon laser trabeculoplasty and intravitreal injection of bevacizumab and ranibizumab. 

The underlying mechanism for elevated intraocular pressure in these patients is apparently similar to that of other uveitic open-angle glaucomas – namely trabecular swelling, trabecular obstruction with cell/debris, and/or trabecular hyalinization.

Most of the cases have been Caucasians or blacks. Wei has reported one Asian patient with Grant's syndrome.

Patients, often >50 years old, present with high IOP (30-70 mmHg), frequently in both eyes (86% of cases). There is a female predominance in most cases (79%).

Characteristically there are yellowish trabecular meshwork (TM) precipitates with or without light anterior chamber flare and cells. Often, the TM precipitates are the only sign of inflammation. As other inflammatory signs usually were absent or minimal, it is easy to be misdiagnosed as primary open angle glaucoma (POAG).

Black arrow= PAS; White arrow= precipitates

The syndrome is diagnosed based on clinical manifestations. 

A few systemic conditions such as Sarcoidosis, rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have been reported to be associated with Grant's syndrome. Scleritis, chronic uveitis and Posner-Schlossman syndrome (PSS) have also been reported to accompany Grant's syndrome. However, these diseases usually have other obvious inflammation signs, such as ciliary congestion, anterior chamber cells, and keratic precipitates.

Typical gonioscopic findings in Grant's syndrome are TM precipitates and scattered irregular peripheral anterior synechiae (PAS). Long-standing TM precipitates can prompt development of PAS. So, patients can be misdiagnosed with primary angle-closure glaucoma (PACG), especially those patients with a shallow anterior chamber. In PACG, PAS first appear superiorly and nasally, whereas inflammatory PAS are observed in areas where TM precipitates have been present and tend to distribute in all segments of the chamber angle.

Ultrasound biomicroscopy showing precipitates 

The patients typically do not respond well to anti-glaucoma treatment. However, the condition usually resolves with corticosteroid treatment.

The condition is prone to recurrence; up to 64% of cases may have recurrence of glaucoma in long-term follow-up.

Prognosis is usually good if treated promptly, the inflammation and pressure can be controlled, but regular follow-up is necessary due to the potential for recurrences.

AICARDI-GOUTIERES SYNDROME

Aicardi–Goutières syndrome (AGS) is a rare autoimmune neurological disorder belonging to type I interferonopathies. 

There are seven subtypes based on the different pathogenic genes: three prime repair exonuclease 1 (TREX1) (AGS1), RNASEH2B (AGS2), RNASEH2C (AGS3), RNASEH2A (AGS4), SAMHD1 (AGS5), ADAR1 (AGS6) and IFIH1 (AGS7).

Mutations affecting RNASEH2B and TREX1 are reported to be the most common, representing 35% and 17% of all cases, respectively.

AGS is usually inherited in an autosomal recessive manner. However, there may also be de novo or inherited autosomal dominant pathogenic variants in TREX1 or ADAR, as well as heterozygous autosomal dominant pathogenic variants in IFIH1. Mutations in the above genes affect the targeting and/or metabolism of nucleic acids, thereby promoting a type I interferon (IFN-I)-mediated innate immune response.

AGS was first described by Jean Aicardi and Francoise Goutières in 1984 with a case series of eight children from five families with severe early-onset encephalopathy. 

The major clinical features of AGS include encephalopathy, significant intellectual disability, acquired microcephaly during the first year of life, dystonia, spasticity, sterile pyrexias, intracranial calcifications, white matter lesions, brain atrophy, bilateral striatal necrosis, chilblain lesions on the feet, hands, ears or more diffuse throughout the skin.

The characteristic features include lymphocytosis, high levels of interferon α (IFN-α) in the cerebrospinal fluid (CSF) and serum with an increased expression of interferon-stimulated genes (ISGs) in the peripheral blood—the so-called “interferon signature”.

Patients may also have intracerebral vasculopathy, hepatosplenomegaly, elevated liver enzymes, thrombocytopenia, hemolytic anemia, elevated autoantibodies, hypothyroidism, insulin-dependent diabetes mellitus, transitory antidiuretic hormone deficiency, neonatal cardiomyopathy and demyelinating peripheral neuropathy.

In the most severe form, this condition features microcephaly, leukodystrophy, cerebral atrophy, intracranial calcifications, along with hepatosplenomegaly and thrombocytopenia. It is associated with elevated levels of central nervous system type I interferon signaling and often progresses with severe neurologic symptoms and death in early childhood. However, milder forms may show later onset with features of a lupus-like syndrome including painful skin lesions and congenital glaucoma.

AGS is often mistaken for TORCH (Toxoplasmosis, Others, Rubella, Cytomegalovirus, Herpes) infections.

Ocular manifestations include glaucoma (congenital or later onset), optic atrophy, and cortical blindness. 

Most cases of glaucoma are diagnosed within the first 6 months of life. Studies have shown that the risk of glaucoma development differs depending on the specific genetic mutation. In a study of AGS, glaucoma was diagnosed in 6.3%, of which 20.8% were patients with a pathological SAMHD1. The ADAR and IFIH1 mutations were found to be the least associated with glaucoma.

Congenital glaucoma can be considered as a part of the phenotypic spectrum of AGS; therefore, regular ophthalmological examinations are essential, especially in the first years of a child’s life, in order to diagnose the disease and promptly initiate treatment.

WORLD GLAUCOMA WEEK

The World Glaucoma Association celebrates the World Glaucoma Week every year with a novel theme. 

This year the week was marked from 8-14th March with the theme "Uniting for a glaucoma free world". 

This week is an important occasion to reinforce the importance of early detection of glaucoma, and using this period to perform extensive screenings for glaucoma. It is also necessary to disseminate information among the public about the disease, sharing awareness materials (like the green ribbon), and emphasise the necessity for regular follow ups with their eye health practitioners.

The at-risk categories such as people over 40, those with a family history of glaucoma, or diabetics should be reviewed more frequently.

In conjunction with this year's glaucoma week, we have also performed our bit to screen and treat for glaucoma.

Dr. Syed Shoeb Ahmad 

Ahmed Glaucoma Valve for NVG in PDR vs. CRVO

Is there any difference in the outcomes after Ahmed Glaucoma Valve (AGV) implantation in patients who develop neovascular glaucoma (NGV) following proliferative diabetic retinopathy (PDR), as compared to NGV following central retinal vein occlusion (CRVO)?

Kanra et al, performed a study in which AGV implantation was performed in NGV patients who developed following PDR (n=28), and CRVO (n=18). All AGV implantation surgeries were done by the same surgeon.

Surgical success was defined as ≥20% intraocular pressure (IOP) reduction from baseline and IOP ≤ 21 mm Hg without additional glaucoma surgery or vision loss to no light perception. 

The study found that the mean surgical success duration was longer in PDR (45.87 mo) than in CRVO (38.68 mo).

One-year, 2-year, and 3-year success rates were 95.5%, 90.4%, and 90.4% in PDR, compared with 92.3%, 64.6%, and 55.4% in CRVO. 

Early complications, such as hyphema, were more frequent in PDR but not statistically significant. 

Tube exposure was observed in only one case (2.1% of total cases), which was in the CRVO group. 

Tube explantation was performed in 2 patients (4.2% of total cases) which included the patient with tube exposure . 

The study found that older age was a significant risk factor for failure (HR = 1.066, P = 0.049).

The study concluded that, AGV implantation provides favorable long-term outcomes for NVG secondary to PDR and CRVO, but with higher success rates in PDR.

REFERENCE:

Kanra, Ayşe Yağmur; Dursun Yilmazşamli, Tuğçe; Altinel, Meltem Güzin; İmamoğlu, Serhat. Surgical Outcomes of Ahmed Glaucoma Valve in Neovascular Glaucoma Secondary to Diabetic Retinopathy Versus Central Retinal Vein Occlusion. Journal of Glaucoma 35(3):p 190-197, March 2026. | DOI: 10.1097/IJG.0000000000002680

DOES GLAUCOMA PROGRESS AFTER REFRACTIVE SURGERY?

Glaucoma is not a contraindication for refractive surgery performed to remove glasses. However, is there any association between these surgeries and glaucoma progression?

A retrospective observational cohort study by Sujin and Rim, included 65 eyes of 65 patients with primary open angle glaucoma (POAG) who underwent refractive corneal surgery (RCS). 

Glaucoma progression was determined based on structural changes in optic disc/retinal nerve fiber layer (RNFL) photographs and/or visual field (VF) deterioration. 

Cox proportional hazards analysis was used to identify risk factors for disease progression. 

VF mean deviation (MD) and RNFL thickness progression rates obtained using a linear mixed-effects model were compared across tertile groups based on axial length (AXL) and central corneal thickness (CCT), respectively.

Over the follow-up period (mean: 9.1±2.9 y), 23 eyes (35%) exhibited glaucomatous progression. 

The progression group had significantly longer AXL (P<0.001), thinner CCT (P=0.009) compared with those in the stable group. 

Multivariate analysis identified longer AXL [hazard ratio (HR): 1.507, P=0.037] and thinner CCT (HR: 0.988, P=0.037) as significant predictors of glaucoma progression. 

VF MD declined faster in the middle and highest AXL tertile groups, whereas RNFL thinning was the most pronounced in the highest AXL tertile group. 

The lowest CCT tertile group exhibited the fastest VF MD decline and RNFL thinning.

Conclusion:

Patients with POAG and a history of RCS who present with longer axial length and thinner central corneal thickness, are at significantly higher risk of glaucomatous progression, highlighting the importance of vigilant long-term monitoring in these eyes.

REFERENCE:

Yeo S, Sung KR. Factors Associated With Glaucomatous Progression in Eyes With Prior Refractive Corneal Surgery. J Glaucoma. 2026 Mar 1;35(3):157-165. doi: 10.1097/IJG.0000000000002682. Epub 2025 Dec 17. PMID: 41474867.

GLOBAL BLINDNESS FROM GLAUCOMA

A population-based observational study was published by Sun et al, to estimate the global prevalence of blindness and vision loss caused by glaucoma, and to evaluate the impact of socioeconomic factors on it. 

The prevalence of blindness and vision loss due to glaucoma were obtained from the Global Burden of Disease Study 2017 database. The Human Development Index (HDI), inequality-adjusted HDI and other socioeconomic data were acquired from international open databases. 

In 2020, glaucoma caused 11% of all global blindness in adults aged 50 years and older.

In 2020, 4.13 million people aged 50 years and older suffered moderate and severe vision impairment, and 3.6 million were blind due to glaucoma. 

The prevalence of glaucoma varies among different nations and regions. It appears to be highest among persons of African descent (ranging from 6.5% to 7.3%), followed by East Asian populations (ranging from 2.59% to 3.54%). This may be compared with figures from European-derived populations, which have been reported to fall below 2.0%.

The overall prevalence worldwide was 81.5 (95% CI 69.9 to 95.0) per 100 000 in 1990 and 75.6 (95% CI 65.0 to 88.1) per 100 000 in 2017. The age-standardised prevalence of cases per 100 000 in 2017 was highest in African region (171.5, 95% CI 146.9 to 200.2) and lowest in Region of the Americas (61.1, 95% CI 52.6 to 70.7). 

In terms of annual change between 1990 and 2017, the greatest increase in the prevalence was in Côte d’Ivoire (108.3) per 100,000, while the greatest decrease was in Qatar (−167.1) per 100 000.

The prevalence of blindness and vision loss due to glaucoma in 2017 among men was higher than that among women (men vs women：6.07, 95% CI 3.79 to 8.81 vs 5.42, 95% CI 3.40 to 7.81) per 100 000. The prevalence for both sexes increased as age rose from 45 years to 95 years.

Among the six WHO regions, the highest age-standardised prevalence of blindness and vision loss due to glaucoma was in the Eastern Mediterranean between 1990 and 2005 and in the African region between 2006 and 2017. By contrast, the region of the Americas had the lowest prevalence during the most period from 1990 to 2017 (63.0 per 100 000 in 1990, and 61.1 per 100 000 in 2017).

With respect to income, the highest age-standardised prevalence was found in the World Bank’s low-income regions (157.2 per 100 000 in 2017), while the lowest prevalence was found in high-income regions (42.7 per 100 000 in 2017) with statistical significance (p<0.001).

Similarly, the age-standardised prevalence was highest in low-SDI regions (111.2 per 100 000 in 2017) and lowest in high-SDI level regions (40.3 per 100 000 in 2017) (p<0.001). SDI is a measure of sociodemographic development based on educational attainment, average income per capita and total fertility rate. SDI varies from 0 to 1, and a higher value suggests a higher educational attainment and per capita income, and a lower total fertility rate. 

The results showed that the worldwide age-standardised prevalence of blindness and vision loss due to glaucoma decreased from 81.5 per 100 000 in 1990 to 75.6 per 100 000 in 2017, and the prevalence increased with age and is higher among men. 

GNI per capita, expected years of schooling and age-standardised prevalence of cataract and refractive disorder was the associated factors with the prevalence of blindness and vision loss due to glaucoma when adjusting for the influence of socioeconomic factors and healthcare indicators.

Although the number of glaucoma patients aged 40–80 years was predicted to increase to 76 million in 2020, and the number of blind or visually impaired due to glaucoma increased by 0.8 million and 2.3 million from 1990 to 2010, respectively, age-standardised prevalence of blindness and vision loss due to glaucoma decreased between 1990 and 2017. This may be mainly explained by the revolution in diagnostic methods such as optical coherence tomography (OCT), OCT angiography and automated perimetry, which has made early detection of asymptomatic glaucoma possible, at least in high-income countries, where access to such technology is better. 

REFERENCE:

Sun Y, Chen A, Zou M, Zhang Y, Jin L, Li Y, Zheng D, Jin G, Congdon N. Time trends, associations and prevalence of blindness and vision loss due to glaucoma: an analysis of observational data from the Global Burden of Disease Study 2017. BMJ Open. 2022 Jan 6;12(1):e053805. doi: 10.1136/bmjopen-2021-053805. PMID: 34992115; PMCID: PMC8739070.

LOW DOSE HYDROCORTISONE IN OSD PATIENTS

 

This study reports the effects of topical low-dose preservative-free hydrocortisone on intraocular pressure in patients affected by ocular surface disease with and without glaucoma.

Similar product 

Purpose:

A study was performed by Filippelli et al, to investigate the safety and efficacy of short-term treatment for ocular surface disease (OSD) with topical low-dose (1.005 mg) preservative-free hydrocortisone in one hundred patients with and without glaucoma.

Methods: 

This was an open label non-randomized clinical trial. Patients with OSD with and without primary open-angle glaucoma (POAG) received topical low-dose (1.005 mg) preservative-free hydrocortisone twice daily in each eye for 2 weeks. All patients underwent a complete ophthalmological examination at baseline (T0) and at 1 (T1) and 2 (T2) weeks post-treatment. At each visit, the intraocular pressure (IOP) and the ocular surface disease index (OSDI) questionnaire scores were recorded; the Schirmer test was performed only at T0 and T2.

Results: 

The OSDI score significantly decreased in both the POAG and no-POAG groups (both p < 0.0001) after hydrocortisone treatment, with no difference between the two groups (p = 0.72). There were no significant differences in IOP and Schirmer test results between T0 and T2 in both treatment groups (p = 0.68 and p = 0.83, respectively).

Conclusions: 

Topical low-dose (1.005 mg) preservative-free hydrocortisone is safe and effective for improving OSD symptoms both in patients with and without POAG.

REFERENCE:

Filippelli M, dell'Omo R, Gelso A, Rinaldi M, Bartollino S, Napolitano P, Russo A, Campagna G, Costagliola C. Effects of topical low-dose preservative-free hydrocortisone on intraocular pressure in patients affected by ocular surface disease with and without glaucoma. Graefes Arch Clin Exp Ophthalmol. 2022 Jan;260(1):247-253. doi: 10.1007/s00417-021-05345-3. Epub 2021 Aug 18. PMID: 34406502.

CENTRAL CORNEAL THICKNESS (CCT)

1. Central cornea thickness (CCT) is regarded as an indispensable investigation in the workup of any glaucoma suspect patient.
2. There are several biological factors and genetic components that may influence glaucoma progression, which have been associated with thinner CCT. 
3. The CCT itself can be affected by several factors including ethnicity, age, sex, glaucoma medications, genetics, and the subtype of glaucoma. 
4. There is also variability in the measurement of CCT between difference types of devices. 
5. These factors need to be considered in the evaluation of glaucoma patients' CCT and its effect on interpretation of intraocular pressure (IOP) levels and risk stratification.
6. Thinner CCT is found more often in patients with normal tension glaucoma (NTG) and angle closure, African American and Japanese patients, those with more advanced glaucoma and is an independent risk factor in ocular hypertension (OHTN). 
7. Its predictive value in established glaucoma is not proven; however, it is important in interpreting IOP results and risk stratification. 
8. The association of CCT with biological factors and genetics in glaucoma will hopefully become clearer as the research expands in these areas.
9. The use of devices that measure IOP independently of CCT would help to overcome its influence; however, they are still not widely incorporated into general clinical practice. 
10. Despite many proposed mathematical models, correcting Goldmann Applanation Tonometry (GAT) IOP does not provide any benefit in the assessment or management of glaucoma. 
11. Correcting methods introduce other errors into the interpretation of the IOP results. In addition, the adjusted IOP is unlikely to improve tonometry as a screening tool for open angle glaucoma (OAG) in at-risk populations and is not necessary in population-based assessment. Therefore, attempting to “correct” IOP based on CCT does not provide any benefit in the assessment or management in the glaucoma or glaucoma suspect patient.

REFERENCE:

Belovay GW, Goldberg I. The thick and thin of the central corneal thickness in glaucoma. Eye (Lond). 2018 May;32(5):915-923. doi: 10.1038/s41433-018-0033-3. Epub 2018 Feb 15. PMID: 29445115; PMCID: PMC5944650.

LASER DOPPLER HOLOGRAPHY

Monitoring retinal blood flow appears crucial to understand the pathophysiology of ocular diseases such as glaucoma, diabetic retinopathy, and age-related macular degeneration (AMD).

LDH setup 

Montage of LDH images

Laser Doppler Holography (LDH) is a full-field imaging technique that measures blood flow, specifically in the retina and choroid, by recording the interference between light backscattered by moving blood cells and a reference beam.

The LDH technique allows parallelized imaging, higher acquisition speed, and offline numerical processing.

It also allows full-field imaging, which is not possible with OCT angiography (OCT-A).

LDH, OCG, OCT-A, OCT

In LDH, the optical field serving as non-Doppler shifted light is a separate reference beam beating against the Doppler shifted optical field backscattered by the retina. This allows the power of the reference field impinging on the sensor to be altered and thus be able to work with very low exposure time. 

Interferograms are recorded with a high throughput camera and wideband measurements of the beat frequency of digitally reconstructed holograms are performed. 

The angiographic contrast is drawn from the Doppler spectral broadening of light backscattered by the retina and blood flow changes during cardiac cycles as revealed using a short-time Fourier transform analysis. Such short acquisition times in the realm of a single cardiac cycle are not possible with OCT-A.

The light source used in LDH is a 45 mW, single-mode, fiber diode laser (Newport SWL-7513-H-P) at wavelength λ = 785 nm. The retina is illuminated with a 1.5 mW constant exposure over 2.4 × 2.4 mm2 area.

The laser beam is focused in the front focal plane of the eye so that the light is collimated inside the eye and illuminates the retina on an extended area. 

A Polarizing Beam Splitter (PBS) cube is used in the object arm to illuminate the eye and collect the light backscattered by the retina.

The object and reference waves are combined using a non-polarizing beam splitter cube and they interfere on the sensor plane.

Power Doppler images drawn from the Doppler power spectrum density qualitatively show blood flow in retinal vessels over 512 × 512 pixels covering 2.4 × 2.4 mm2 on the retina with a temporal resolution down to 1.6 ms.

A study by Lecoge and colleagues found median postoperative decrease in IOP of 23 mmHg (20–25.5) was associated with an improvement in diastolic central retinal artery flow [EDV significatively increased (P = 0.029)], and resistivity index significatively decreased (P = 0.029). 

(R. Lecoge, P. Bastelica, M. Atlan, J. Buffault, E. Brasnu, M. Paques, C. Baudouin, A. LabbÃ. In vivo Doppler holography of the optic nerve head in glaucoma: Response to acute IOP decrease,Journal Francais d'Ophtalmologie, Volume 49, Issue 3,2026.)

CONCLUSION:

LDH is used for non-invasive, high-resolution imaging of blood flow in the retina and choroid, assisting in studying hemodynamics in healthy and diseased eyes. It offers coherent gain, allowing for high sensitivity, and enables digital aberration correction to improve image quality.

VISUAL FIELD PATTERNS IN GLAUCOMA: A SYSTEMIC REVIEW

INTRODUCTION:

Retinal nerve fiber bundles are arranged in a specific distribution. As the greater part is located in the central 30° area, most early glaucomatous visual field defects (VFDs) are detected within this region. 

Typical glaucomatous visual field patterns include nasal step, paracentral scotoma, arcuate-like defects, diffuse loss, and altitudinal defects. 

Footnote: The blind spot is located at 15° temporally, where the optic nerve leaves the eye.

PRIMARY OPEN ANGLE GLAUCOMA (POAG):

The nasal step is described as the most frequent and earliest VFD, followed by paracentral scotomas and arcuate-like defects. 

The superior hemifield is more affected than the inferior hemifield.

Repeatable diffuse visual field loss was seen in 4.4% of patients, the only sign of early glaucomatous visual field loss. 

Diffuse visual field loss is nonspecific and can be caused by various other factors such as cataract, extreme miosis, and unreliable performance of the perimetry.

Early diffuse visual field loss usually converts into well-defined pattern defects at later stages. 

INFLUENCING FACTORS FOR VFDs IN POAG:

Initial VFDs located in the superior hemifield were associated with greater disc ovality (maximum diameter of an ellipse fitted to disc contour/minimum diameter of an ellipse fitted to disc contour), β-peripapillary atrophy and thinner central corneal thickness.

VFD in the inferior hemifield was more frequently found in both insulin-dependent as noninsulin-dependent diabetic patients (odds ratio [OR] =1.8).

The presence of systemic risk factors for glaucoma (especially NTG) such as hypotension, migraine, Raynaud’s phenomenon, and sleep apnea was significantly higher in POAG as well as NTG patients with an initial parafoveal scotoma than in patients with initial nasal step.

In NTG, these above-mentioned systemic risk factors for glaucoma were more prevalent in patients exhibiting initial central scotoma than in patients with initial peripheral scotoma. These findings suggest that systemic vascular risk factors in POAG and NTG patients are associated with central VFDs.

Body mass index and smoking (measured in pack-years) were more strongly associated with a lower risk of paracentral VFDs (HR [hazard ratio] Body mass index [BMI] =0.67; HR smoking = 0.92) than with peripheral VFDs (HR BMI = 0.93; HR smoking = 0.98). The relation between cigarette smoking and POAG overall has been conflicting. Nicotine has been mentioned to have a neuroprotective role. 

NORMAL TENSION GLAUCOMA:

NTG patients show more localized VFDs and are characterized by deeper, more central, and more depressed VFDs compared to POAG patients. 

PRIMARY ANGLE CLOSURE GLAUCOMA:

In early disease stages, the VFDs are most common in the nasal area.

Jiang et al. and Sim et al. observed that (partial) arcuate defects were the most common types of VFDs in PACG eyes. Atalay et al. showed that the superior hemifield was more impaired than the inferior hemifield across the whole severity spectrum. In contrast, Lau et al. found no significant difference in visual field loss between the superior and inferior hemifield.

Following an acute episode of angle-closure, a hemifield defect was the most common VFD.

PROGRESSION OF VFDs:

Primary-open angle glaucoma:

The most common pattern of progression is the deepening of an existing scotoma, followed by expansion, rather than the development of new scotomas, emphasizing the importance of reliable baseline VF testing.

With increasing severity, the VFD showed progression to the center and progression toward a connection with the blind spot.

The initial parafoveal scotoma showed a characteristic pattern of progression in a retrospective study conducted by Su et al. The parafoveal scotoma in the superior hemifield initially had an arcuate pattern that first deepened 3° to 5° above fixation, then elongated toward the physiologic blind spot, and spread towards the nasal periphery, sparing the area corresponding to the papillomacular bundle. The inferior parafoveal scotoma, showed similar characteristics, but tended to be further away from fixation. POAG patients progress faster in the superior hemifield defects compared to the inferior counterparts. This difference is more pronounced in the central, paracentral, and nasal area.

Patients with initial damage in both hemifields had higher chances of glaucomatous progression.

Normal-tension glaucoma:

NTG patients progress more often in the paracentral area. NTG patients with lower heart-rate variability had faster central visual field progression than those with higher heart-rate variability. Other vascular factors, such as migraine and orthostatic dysfunction were also related to increased central visual field progression.

REFERENCE:

Vandersnickt MF, van Eijgen J, Lemmens S, Stalmans I, Pinto LA, Vandewalle EM. Visual field patterns in glaucoma: A systematic review. Saudi J Ophthalmol. 2024 Dec 26;38(4):306-315. doi: 10.4103/sjopt.sjopt_143_24. Erratum in: Saudi J Ophthalmol. 2025 Oct 13;39(3):286. doi: 10.4103/sjopt.sjopt_374_25. PMID: 39943959; PMCID: PMC11811403.