Meeting News Coverage

Vascular disease may reduce effect of IOP lowering in normal tension glaucoma

VANCOUVER, British Columbia — Factors related to vascular disease may indicate less effect of IOP reduction in patients with normal tension glaucoma, a speaker here said. In particular, family history of stroke and presence of cardiovascular disease may reduce the efficacy of pressure-reducing therapies.

The first challenge is to identify which patients with normal tension glaucoma need their IOP lowered, Frederick S. Mikelberg, MD, FRCSC, said at the World Glaucoma Congress. After that, choosing the best treatment modality and determining the treatment goal are considered.

Citing the Collaborative Normal Tension Glaucoma Study as the landmark study for guiding treatment, Mikelberg said that 65% of patients in the untreated group of that study never showed any progression during 7 years of follow-up.

Data collected in post hoc analysis of the large randomized controlled trial suggested that female gender, presence of disc hemorrhage and presence of migraine may be risk factors for progression.

“Interesting factors that did not show risk were age, the untreated IOP level and a family history of glaucoma,” Mikelberg said.

In further analysis, researchers sought to predict which patients would benefit from IOP lowering.

“IOP reduction may be — and I say just may be — less efficacious if disc hemorrhage is present, in males, if family history of glaucoma is absent, if family history of stroke or cardiovascular disease is present, and in patients with large cup-disc ratios,” Mikelberg said.

Disclosure: Mikelberg has no relevant financial disclosures.

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