Focal ischaemic normal pressure glaucoma versus high pressure glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Research
• Vascular Ophthalmology

Background:

• Normal Pressure Glaucoma (NPG) presents diagnostic challenges.
• Identifying subgroups within NPG is crucial for understanding disease progression and prognosis.
• Focal Ischaemic NPG (FINPG) represents a specific subtype requiring detailed investigation.

Purpose of the Study:

• To characterize the Focal Ischaemic Normal Pressure Glaucoma (FINPG) subgroup.
• To identify and compare risk factors associated with FINPG versus High Pressure Glaucoma (HPG).
• To investigate the clinical presentation and progression patterns of FINPG.

Main Methods:

• Patient cohort: 130 Normal Pressure Glaucoma (NPG) patients, with 26 classified as Focal Ischaemic NPG (FINPG).
• Comparative analysis with a control group of High Pressure Glaucoma (HPG) patients.
• Ophthalmic examination including visual field testing, funduscopy (assessing papillary hemorrhages, choroidal sclerosis, peripapillary atrophy), and chamber angle evaluation.

Main Results:

• FINPG subgroup exhibits characteristic disc and corresponding visual field defects, more prevalent in the upper visual field.
• FINPG patients showed significantly higher incidence of hypertension/cardiovascular disorders (65.4%) compared to HPG (22.2%).
• Papillary hemorrhages (46%) and choroidal sclerosis (30%) were significantly more frequent in FINPG than HPG (11% and 0%).
• Peripapillary atrophy distribution differed, with more atrophy on the side of the papillary defect in FINPG.
• FINPG demonstrated a higher rate of progression (38.5%) than initially presumed.

Conclusions:

• FINPG is a distinct NPG subgroup with specific clinical and etiological characteristics.
• Systemic vascular factors and local vascular signs are significantly associated with FINPG.
• Recognition of FINPG and its risk factors aids in improving prognostic assessments for NPG patients.