Off anti-glaucoma medication study: changes in visual field, retinal nerve fiber layer thickness and riskestimation of glaucoma onset in 1 year follow up

Abstract

Objective: To examine the changes of visual field and retinal nerve fiber layer (RNFL) measurements and the risk of glaucoma progression before and after taking off intraocular pressure (IOP) lowering medication in Chinese patients with ocular hypertension.

Design: Prospective study.

Participants: 106 ocular hypertension patients (4 were excluded because there was no 1 year follow up examination).

Method: All patients underwent visual field testing by Humphrey Field Analyser and Retinal Nerve Fiber Layer (RNFL) thickness measurement by a spectral-domain optical coherence tomography. Eyes without glaucomatous visual field defect and had an IOP ?30mmHg were instructed to stop taking IOP lowering medication and measurements of IOP, visual field and RNFL measurements were taken. Changes in the visual field mean deviation, average, superior and inferior RNFL thickness and the risk of developing glaucoma between the baseline and follow-up examinations were compared between the groups with and without stopping IOP lowering medications. Logistic regression was used to analyze the association between corneal hysteresis, ocular pulse amplitude and the onset of glaucoma.

Results: There were 73 patients with IOP lowering medications taken off and 29 with continued medications. No significant differences were found in the changes of visual field mean deviation, average RNFL thickness and the risk of glaucoma progression (P=0.92, P=0.81, P=0.35, respectively) between the groups. Ocular pulse amplitude was a significant predictor of glaucoma development by functional (-0.61, P=0.047) and structural criteria (-0.74, P=0.024).

Conclusion: There were no functional and structural changes in patients with ocular hypertension after stopping IOP lowering medications in one year. Low ocular pulse amplitude could be a predictive factor for the conversion from ocular hypertension to glaucoma. Clinicians should not prescribe IOP-lowering medication simply base on high IOP.