TY - JOUR
T1 - Risk factors for visual field progression in the low-pressure glaucoma treatment study
AU - De Moraes, Carlos Gustavo
AU - Liebmann, Jeffrey M.
AU - Greenfield, David S.
AU - Gardiner, Stuart K.
AU - Ritch, Robert
AU - Krupin, Theodore
N1 - Funding Information:
All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Financial disclosures: C.G. De Moraes: grant support, Edith C. Blum Foundation , New York Glaucoma Research Institute ; JM Liebmann: consultant/advisor, Alcon Laboratories, Inc; Allergan, Inc; Diopsys Corporation; Merz Pharmaceuticals, Inc; Optovue, Inc; Quark Pharmaceuticals, Inc; Topcon Medical Systems; grant support, Carl Zeiss Meditec , Diopsys Corporation , Heidelberg Engineering , National Eye Institute , New York Glaucoma Research Institute , Optovue , Topcon Medical Systems ; D.S. Greenfield: consultant/advisor, Allergan, Inc; Alcon, Inc; Topcon, Inc; Merz; SOLX; grant support, National Eye Institute , Carl Zeiss Meditec , Optovue , Heidelberg Engineering ; R Ritch: consultant/advisor, iSonic, Aeon Astron, Drais Pharmaceutical, Medacorp; lecture fees: Pfizer, Merck; patents/royalty, Ocular Instruments, Inc.; T Krupin: consultant/advisor, Allergan, Inc. Publication of this article was supported by funding provided by Allergan, Inc, Irvine, California; the Chicago Center for Vision Research, Chicago, Illinois; Research to Prevent Blindness, Inc, New York, New York; and Ralph and Sylvia Ablon Research Fund of the New York Glaucoma Research Institute, New York, New York. Study medications were provided by Allergan, Inc. Dr De Moraes is the Edith C. Blum Foundation Research Scientist, New York Glaucoma Research Institute, New York, New York. Involved in design and conduct of the study (T.K., R.R., J.M.L., D.S.G.); collection, management, analysis, and interpretation of the data (T.K., R.R., J.M.L., D.S.G., S.K.G., C.G.D.M.); and preparation, review, or approval of the manuscript (T.K., R.R., J.M.L., D.S.G., S.K.G., C.G.D.M.). The institutional review boards at all 13 participating centers approved the prospective study protocol and patients gave informed consent to participate in this research study. Clinical trial ( www.clinicaltrials.gov ) ID: NCT00317577 .
PY - 2012/10
Y1 - 2012/10
N2 - Purpose: To investigate risk factors associated with visual field progression in the Low-pressure Glaucoma Treatment Study, a prospective trial designed to compare the effects of the alpha2-adrenergic agonist brimonidine tartrate 0.2% to the beta-adrenergic antagonist timolol maleate 0.5% on visual function in low-pressure glaucoma. Design: Prospective cohort study. Methods: Low-pressure Glaucoma Treatment Study patients with <5 visual field tests during follow-up were included. Progression was determined using pointwise linear regression analysis, defined as the same 3 or more visual field locations with a slope more negative than -1.0 dB/year at P < 5%, on 3 consecutive tests. Ocular and systemic risk factors were analyzed using Cox proportional hazards model and further tested for independence in a multivariate model. Results: A total of 253 eyes of 127 subjects (mean age, 64.7 ± 10.9 years; mean follow-up, 40.6 ± 12 months) were analyzed. Eyes randomized to timolol progressed faster than those randomized to brimonidine (mean rates of progression, -0.38 ± 0.9 vs 0.02 ± 0.7 dB/y, P <.01). In the final multivariate model adjusting for all tested covariates, older age (hazard ratio [HR] = 1.41/decade older, 95% confidence interval [CI] = 1.05 to 1.90, P =.022), use of systemic antihypertensives (HR = 2.53, 95% CI = 1.32 to 4.87, P =.005), and mean ocular perfusion pressure (HR = 1.21/mm Hg lower, 95% CI = 1.12 to 1.31, P <.001) were associated with progression whereas randomization to brimonidine revealed a protective effect (HR = 0.26, 95% CI = 0.12 to 0.55, P <.001). Conclusions: While randomization to brimonidine 0.2% was protective compared to timolol 0.5%, lower mean ocular perfusion pressure increased the risk for reaching a progression outcome in the Low-pressure Glaucoma Treatment Study. This suggests that the beneficial effect of randomization to the brimonidine arm was independent of possible differences in ocular perfusion pressures between the 2 treatment arms. The current results and large number of drop-outs in the brimonidine 0.2% arm suggest that more research is necessary before altering clinical practice paradigms.
AB - Purpose: To investigate risk factors associated with visual field progression in the Low-pressure Glaucoma Treatment Study, a prospective trial designed to compare the effects of the alpha2-adrenergic agonist brimonidine tartrate 0.2% to the beta-adrenergic antagonist timolol maleate 0.5% on visual function in low-pressure glaucoma. Design: Prospective cohort study. Methods: Low-pressure Glaucoma Treatment Study patients with <5 visual field tests during follow-up were included. Progression was determined using pointwise linear regression analysis, defined as the same 3 or more visual field locations with a slope more negative than -1.0 dB/year at P < 5%, on 3 consecutive tests. Ocular and systemic risk factors were analyzed using Cox proportional hazards model and further tested for independence in a multivariate model. Results: A total of 253 eyes of 127 subjects (mean age, 64.7 ± 10.9 years; mean follow-up, 40.6 ± 12 months) were analyzed. Eyes randomized to timolol progressed faster than those randomized to brimonidine (mean rates of progression, -0.38 ± 0.9 vs 0.02 ± 0.7 dB/y, P <.01). In the final multivariate model adjusting for all tested covariates, older age (hazard ratio [HR] = 1.41/decade older, 95% confidence interval [CI] = 1.05 to 1.90, P =.022), use of systemic antihypertensives (HR = 2.53, 95% CI = 1.32 to 4.87, P =.005), and mean ocular perfusion pressure (HR = 1.21/mm Hg lower, 95% CI = 1.12 to 1.31, P <.001) were associated with progression whereas randomization to brimonidine revealed a protective effect (HR = 0.26, 95% CI = 0.12 to 0.55, P <.001). Conclusions: While randomization to brimonidine 0.2% was protective compared to timolol 0.5%, lower mean ocular perfusion pressure increased the risk for reaching a progression outcome in the Low-pressure Glaucoma Treatment Study. This suggests that the beneficial effect of randomization to the brimonidine arm was independent of possible differences in ocular perfusion pressures between the 2 treatment arms. The current results and large number of drop-outs in the brimonidine 0.2% arm suggest that more research is necessary before altering clinical practice paradigms.
UR - http://www.scopus.com/inward/record.url?scp=84866426613&partnerID=8YFLogxK
U2 - 10.1016/j.ajo.2012.04.015
DO - 10.1016/j.ajo.2012.04.015
M3 - Article
C2 - 22835512
AN - SCOPUS:84866426613
VL - 154
SP - 702
EP - 711
JO - American Journal of Ophthalmology
JF - American Journal of Ophthalmology
SN - 0002-9394
IS - 4
ER -