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Gülgün Tezel, MD; Kim D. Siegmund, PhD; Kathryn Trinkaus, PhD; Martin B. Wax, MD; Michael A. Kass, MD; Allan E. Kolker, MD

Arch Ophthalmol. 2001;119:813-818.

Background  Reducing intraocular pressure (IOP) in glaucomatous eyes does not always prevent disease progression.

Objective  To determine the clinical factors associated with progressive optic disc damage in glaucomatous eyes receiving treatment to reduce IOP.

Methods  Baseline and follow-up optic disc photographs as well as demographic and clinical data were retrospectively studied in 186 eyes of 93 patients with primary open-angle glaucoma, and in 138 eyes of 69 patients with normal-pressure glaucoma. The patients with primary open-angle glaucoma were included in the study only if their treated IOPs during a follow-up period of 5 years were less than 21 mm Hg. The patients with normal-pressure glaucoma were included only if their IOPs were reduced by at least 20% during the follow-up period. The association of progressive optic disc damage with patient- and eye-specific characteristics was examined using multivariate analysis.

Results  During the 5-year study period, 141 (43.5%) of the 324 eyes exhibited progressive optic disc damage defined by at least a 5% decrease in the neural rim area-to-disc area ratio. Using multivariate analysis, the following were found to be strongly associated with progressive neural rim damage: a baseline smaller neural rim area-disc area ratio (P<.001); a baseline larger zone area-disc area ratio (P = .04); a baseline larger parapapillary atrophy length-disc circumference ratio (P = .05); a diagnosis of normal-pressure glaucoma (P = .01); and combined medical and surgical treatment prior to the study period (P = .01).

Conclusions  Clinical factors other than IOP may be important indicators of subsequent progression of glaucomatous optic disc damage. Our findings suggest that eyes with advanced glaucomatous optic disc damage and normal-pressure glaucoma are more likely to progress despite receiving treatment to reduce IOP.

From the Department of Ophthalmology and Visual Sciences (Drs Tezel, Wax, Kass, and Kolker), and the Division of Biostatistics (Dr Trinkaus), Washington University School of Medicine, St Louis, Mo; and the Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, Calif (Dr Siegmund). The authors have no proprietary interest in any of the materials used in this study.

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