Natural History and Risk Factors for Glaucoma Progression in Chinese Patients With Normal-Tension Glaucoma.

Area of Science:

• Ophthalmology and Optometry
• Glaucoma Research
• Clinical Epidemiology

Background:

• Normal-tension glaucoma (NTG) is a significant cause of irreversible blindness worldwide.
• Understanding the natural history and progression factors of NTG in diverse populations is crucial for effective management.
• Chinese patients represent a distinct demographic group where NTG characteristics may vary.

Purpose of the Study:

• To characterize the natural history of normal-tension glaucoma (NTG) in a cohort of Chinese patients.
• To identify predictors of functional and structural progression in untreated NTG.

Main Methods:

• Prospective observational cohort study of untreated Chinese patients newly diagnosed with NTG.
• Minimum follow-up duration of 2 years.
• Functional progression assessed by visual field (VF) deterioration; structural progression by retinal nerve fiber layer (RNFL) or ganglion cell inner plexiform layer (GCIPL) thinning.

Main Results:

• 63.1% of 84 participants progressed over an average follow-up of 69.7 months.
• Visual field progression occurred in 29.8%, and RNFL/GCIPL thinning in 48.8%.
• Significant predictors of progression included disc hemorrhage (HR 2.82), female gender (HR 1.98), and mean intraocular pressure (IOP) (HR 1.14 per mmHg). Longer axial length (AL) was protective against VF progression, and higher minimum diastolic blood pressure (DBP) was protective against structural progression.

Conclusions:

• A substantial proportion of untreated Chinese NTG patients experience disease progression over a mean follow-up of 70 months.
• Disc hemorrhage, female gender, elevated mean IOP, shorter axial length, and lower minimum diastolic blood pressure are significant predictors for NTG progression.
• These findings highlight the importance of monitoring and risk stratification in Chinese NTG patients.