Nocturnal diastolic hypotension is associated with central visual field defect in early and moderate normal tension glaucoma.

Abstract

Purpose: To investigate the association between systemic blood pressure-related hemodynamic indices and central-most visual field defect (CMVFD) in patients with early and moderate normal tension glaucoma (NTG).

Methods: This cross-sectional study examined 36 eyes of 36 early and moderate NTG patients with CMVFD from 295 consecutive NTG patients who underwent 24-h ambulatory blood pressure monitoring (ABPM). Hemodynamic variables and ocular examination results were compared between two groups. CMVFD was defined as a glaucomatous defect with at least one abnormal point at P < 1% within the central 5 degrees on two consecutive 24-2 or 30-2 visual field tests.

Results: There were no significant differences in baseline demographics except for body weight (P = .009). The cup-to-disc ratio, pattern standard deviation in visual field test, and inferotemporal segmental thickness of retinal nerve fiber layer in OCT showed significant differences in the ophthalmic examinations. Univariate logistic regression analysis revealed significant association between CMVFD and 24-h average diastolic blood pressure, nighttime average systolic blood pressure, nighttime average diastolic blood pressure, and body weight. In multivariate logistic regression analysis, only the nighttime average diastolic blood pressure (odds ratio [OR] 0.877; P = .037) was independently associated with CMVFD in early and moderate NTG.

Conclusion: Central-most visual field defects were identified in some patients with early and moderate NTG. Particularly, low nocturnal diastolic blood pressure (nocturnal diastolic hypotension) was independently related to CMVFD, and should be considered when managing systemic care for NTG patients.

Key messages: What is known: • The visual field defects are at greater risk in glaucoma patients with nocturnal hypotension.

What is new: • The nocturnal diastolic hypotension is independently related to the presence of central-most visual field defect (CMVFD) in patients with early and moderate normal tension glaucoma. • If average nocturnal diastolic blood pressure is found to be low, it should be considered a modifiable risk factor for CMVFD.