Fast Central Visual Field Progression in Patients With Normal-Tension Glaucoma and Nocturnal Blood Pressure Dip

Area of Science:

• Ophthalmology
• Cardiology
• Nephrology

Background:

• Normal-tension glaucoma (NTG) is characterized by optic nerve damage and visual field (VF) loss without elevated intraocular pressure.
• Nocturnal blood pressure (BP) dipping patterns, including non-dippers, dippers, and over-dippers, are associated with various cardiovascular and cerebrovascular conditions.
• Understanding factors influencing rapid VF progression in NTG is crucial for timely intervention and preventing vision impairment.

Purpose of the Study:

• To investigate the association between nocturnal BP dip patterns and the rate of central VF progression in patients with early-to-moderate stage NTG.
• To identify whether specific BP dipping categories predict accelerated central VF loss.
• To determine if nocturnal BP dip is a risk factor for fast central VF progression in NTG.

Main Methods:

• A prospective cohort study involving 199 untreated NTG patients.
• 24-hour ambulatory BP monitoring (ABPM) and a minimum 2-year follow-up.
• Classification of patients into non-dippers, dippers, and over-dippers based on nocturnal BP dip; comparison of central VF progression rates using linear mixed models; logistic regression to identify risk factors for fast VF progression (defined as MTD10 decline < -0.5 dB/year).

Main Results:

• Over-dippers exhibited a significantly faster rate of central VF progression (-0.53 dB/year) compared to non-dippers (-0.23 dB/year) and dippers (-0.27 dB/year) (P = .007).
• The prevalence of fast central VF progression was substantially higher in over-dippers (60.0%) versus non-dippers (19.8%) and dippers (23.5%) (P < .001).
• A higher percentage of nocturnal mean arterial pressure (MAP) dip was a significant risk factor for fast central VF progression (OR: 1.062, P < .05).

Conclusions:

• NTG patients classified as over-dippers demonstrate significantly accelerated central VF progression.
• Over 50% of over-dippers experienced rapid central VF progression, highlighting a critical subgroup for monitoring.
• The percentage of nocturnal MAP dip is a significant risk factor for rapid central VF progression in early-to-moderate NTG, emphasizing the need for close monitoring of central VF in these patients.