Gender, Ocular Parameters Determine Initial Site of Glaucomatous Structural Progression

Tomography in Optical Coherence (OCT)
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Identifying clinical factors associated with locational differences may help prevent further glaucoma damage by predicting the site of structural progression in glaucoma, a study suggests.

The location of initial structural progression in normal-tension glaucoma (NTG) may be linked with a variety of clinical factors, according to findings published in the Journal of Glaucoma

Researchers conducted a retrospective analysis of 228 eyes of 228 patients with NTG. They used high-definition optical coherence tomography (HD-OCT) to evaluate initial structural progression, classified as either peripapillary retinal nerve fiber layer (ppRNFL) first or macular ganglion cell inner plexiform layer (mGCIPL) first progression. Researchers tested various clinical factors for association with both ppRNFL and mGCIPL first locations using logistic regression. They obtained best corrected visual acuity, intraocular pressure (IOP), keratometry, axial length, and central corneal thickness measurements for all participants.

Investigators identified 130 eyes of 130 patients with structural progression, 50 with ppRNFL first progression and 64 with mGCIPL first progression. The remaining 16 eyes demonstrated similar progression in both locations.

 A multivariate analysis revealed that ppRNFL first progression was associated with female sex (OR=5.705; 95% Confidence Interval [CI]: 1.407-23.129; P =.015), lack of systemic hypertension (OR=0.199, P =.014), disc hemorrhage (OR=4.188; 95% CI: 1.154-15.204; P =.029), higher mean IOP (OR=1.300; 95% CI: 1.025-1.649; P =.03), and lower pattern standard deviation (OR=0.784; 95% CI: 0.631-0.975; P =.028). 

The team found that mGCIPL first progression was associated with male sex (OR=0.450; P =.043), lower central corneal thickness (OR=0.987; 95% CI: 0.975-0.999; P =.032), higher IOP fluctuation (OR=1.753; 95% CI: 1.007-3.052; P =.047), lower systolic blood pressure fluctuation (OR=0.839; 95% CI: 0.749-0.940; P =.002), and higher diastolic blood pressure fluctuation (OR=1.208; 95% CI: 1.037-1.407; P =.015).

“Our findings suggest that clinical factors can help predict the location where glaucomatous structural progression would occur first,” according to the researchers. “In addition, these results would be helpful for further studies investigating the pathophysiology of glaucoma.”

Limitations of the study included the retrospective design, inclusion of only Korean patients, and the use of a single center design.


Lee SY, Yang H, Lee K, Seong GJ, Kim CY, Bae HW. Factors associated with differences in the initial location of structural progression in normal tension glaucoma. J Glaucoma. Published online January 12, 2022. doi:10.1097/IJG.0000000000001983