Fast progressors in Asian normal-tension glaucoma: 10 years and beyond in a longitudinal cohort

To investigate the characteristics of fast-progressors among Asian patients with normal tension glaucoma (NTG) and identify the risk factors associated with fast progression of glaucoma.

We included 274 eyes of 274 patients with NTG who were treated with topical medication and followed them for more than 5 years. Patients were divided into three groups: fast-progressor (progression ≤ -1 dB mean deviation (MD)/year), moderate-progressor (-1 < progression < -0.5 dB MD/year) and slow-progressor (progression ≥ -0.5 dB MD/year). Comparison among slow, moderate and fast progressing eyes was measured using one-way ANOVA test and χ² test. Logistic regression test and multiple regression test were used to analyse the risk factors for fast progression and MD loss, respectively.

Over a mean follow-up period of 13.0 ± 5.9 years, 30 eyes (10.9%) showed fast progression, 44 (16.1%) showed moderate progression and 200 (73.0%) showed slow progression. Fast-progressors demonstrated a mean MD loss of -1.67 ± 0.52 dB/year and had a higher prevalence of disc haemorrhage (DH) and a lower percentage reduction in intraocular pressure (IOP). Risk factors significantly associated with overall rapid rate of MD loss were DH, percentage reduction in IOP and baseline MD. Notably, progressors with DH exhibited faster functional progression compared with those without DH (p = 0.002).

This longitudinal cohort study highlights distinct progression patterns in Asian patients with NTG, with approximately 10.9% exhibiting fast progression. Insufficient IOP reduction and the presence of DH were associated with rapid progression, emphasising the need for close monitoring of the patients with NTG in Asian populations.