Central visual field progression in normal-tension glaucoma patients with autonomic dysfunction.

Area of Science:

• Ophthalmology
• Neurology
• Cardiology

Background:

• Normal-tension glaucoma (NTG) is a progressive optic neuropathy.
• Autonomic dysfunction, characterized by impaired heart-rate variability, may influence glaucoma progression.
• Understanding risk factors beyond intraocular pressure is crucial for managing NTG.

Purpose of the Study:

• To investigate visual field (VF) progression in normal-tension glaucoma (NTG) patients with varying degrees of autonomic dysfunction.
• To identify clinical factors associated with central VF progression in NTG.

Main Methods:

• Retrospective analysis of 48 NTG eyes with over 5 years of follow-up and at least seven VF tests.
• Heart-rate variability (HRV) assessment to classify patients into lowest and highest HRV groups.
• Comparison of VF progression rates in central and peripheral regions between HRV groups using linear mixed models.

Main Results:

• No significant difference in baseline VF damage or global VF change rates between the lowest and highest HRV groups.
• Significantly faster VF progression in the central (-1.16 dB/year) and superior central (-1.48 dB/year) regions for the lowest HRV group compared to the highest HRV group (-0.52 dB/year and -0.64 dB/year, respectively).
• Baseline VF pattern SD, migraine, orthostatic hypotension, and lower HRV were significantly associated with faster central VF progression.

Conclusions:

• Lower heart-rate variability, indicating autonomic dysfunction with sympathetic predominance, is linked to accelerated central VF progression in NTG patients.
• Intraocular pressure-independent factors including migraine, orthostatic hypotension, and autonomic dysfunction are associated with central VF progression in NTG.