Visual functions dynamic in patients with primary open-angle glaucoma during conservative treatment

PURPOSE: Dynamic measurement of visual functions in patients with primary open-angle glaucoma (POAG) with achieved target pressure during a one-year observation. METHODS: 57 patients (102 eyes) with POAG were observed for a year. Uncorrected visual acuity, best corrected visual acuity, threshold static perimetry, kinetic quantitative perimetry were quantitatively estimated in all the patients. Intraocular pressure (IOP) compensation was assessed according to the National Glaucoma Guidelines with regard to glaucoma stage. Target pressure was achieved in all the patients. All data was statistically analyzed. RESULTS: Uncorrected visual acuity and best corrected visual acuity stayed stable in patients with POAG stage I during the whole observation period, while in patients with POAG stages II-III a statistically verified decrease of uncorrected visual acuity was discovered. We hadn’t observed changes in central vision parameters in patients with POAG stage I in the majority of cases, while 32.9 and 52.9% of patients with POAG stages II-III revealed a visual acuity loss during the year of observation despite the fact that the target pressure was achieved. Retinal sensitivity in the central area stayed stable in the majority (55.6-70.7% depending on the stage and period of observation) of glaucoma patients during the year of dynamic observation. An improvement of threshold static perimetry results was noticed in 32.3-66.7% of cases. Summarized field of vision was measured at eight principle meridians, and it was considered to be the most informative method of studying the peripheral vision. Verified visual field reduction (test-object square = 1 mm²) was noticed in patients with all stages of POAG. Decrease of peripheral vision was observed in 48.1-61.8% cases (depending on the stage and period of observation) even though the target IOP values had been achieved. IOP stabilization with achieved target pressure values was preserved in the majority of cases (81.0-100%, statistically significant interrelation with the stage of glaucoma and observation period was not found). However, in some cases after 6-12 months a subcompensation of IOP was detected (0% in patients with I stage of POAG, 16% and 11.8% - in patients with II and III stage of POAG correspondingly by the end of one-year observation period). Strong statistically significant correlations were found for all parameters of central and peripheral vision and stages of glaucoma at each term of observation. A significant negative correlation was found between glycemia level and dynamics of IOP compensation. Highly significant negative correlations were found between the central and peripheral vision parameters, IOP compensation and anterior chamber angle pigmentation. CONCLUSION: Despite an adequate background therapy, a high degree of compliance and achieved target pressure, negative dynamics in visual functions take place in the majority of patients with POAG. Peripheral visual field reduction (testobject square = 1 mm²) was found in the majority of cases, while summarized sensitivity and depth of suppression within the scotoma in the central visual field area stayed almost the same. Within a year a patient with the I stage of POAG in average loses 52 degrees of peripheral visual field (test-object square = 1 mm²); reduction in visual acuity doesn’t occur; reduction in visual acuity in patients with the II stage of POAG amounts to 0.08, loss of peripheral visual field amounts to 60 degrees, in patients with the III stage of POAG corresponding changes amount to 0.1 and 85 degrees respectively. Negative correlations between the patient’s age, glycemia, anterior chamber angle pigmentation and visual functions dynamics as well as the dynamics of IOP compensation were revealed.

первичная открытоугольная глаукома, зрительные функции, целевое внутриглазное давление, нейропротекторная терапия, primary open-angle glaucoma, visual functions, target pressure, neuroprotective therapy

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