September 30, 2020

Cardiovascular Disease may predict structural and functional progression in early glaucoma

Author(s): Henry Marshall (1), Sean Mullany (2), Ayub Qassim (2), Mark Hassall (2), Owen Siggs (2), Bronwyn Ridge (2), Thi Nguyen (2), Mona Awadalla (2), Nick Andrew (3), Paul Healey (4), Ashish Agar (5), Anna Galanopoulos (6), Alex Hewitt (7), Stuart Macgregor (8), Stuart Graham (9), Richard Mills (2), John Landers (2), Robert Casson (10), Jamie Craig (2)

1 Department of Ophthalmology, Flinders University, Adelaide, South Australia, Australia. Electronic address: h.n.marshall@outlook.com.
2 Flinders University.
3 University of Adelaide, Adelaide, South Australia.
4 University of Sydney, Sydney, Australia.
5 University of New South Wales, New South Wales, Sydney, Australia.
6 University of Adelaide.
7 University of Tasmania, Tasmania, Australia.
8 QIMR Berghofer Medical Research Institute, Herston, Brisbane, Australia.
9 Macquarie University, Sydney, Australia.
10 The University of Adelaide.

PURPOSE: To investigate the association between cardiovascular disease and baseline structural defects and longitudinal disease progression in glaucoma.

DESIGN: Prospective longitudinal cohort study of pre-perimetric and perimetric glaucoma.

PARTICIPANTS: 2628 eyes from 1314 participants recruited to the Progression Risk of Glaucoma: RElevant SNPs with Significant Association (PROGRESSA) study were evaluated for baseline and longitudinal structural thinning on Spectral Domain Optical Coherence Tomography (SD-OCT), and visual field progression on Humphrey Visual Field (HVF) assessment.

METHODS: Patients were classified as showing predominantly mGCIPL, predominantly pRNFL or equivalent mGCIPL and pRNFL structural change at study enrolment. The cardiovascular disease and medication characteristics of these study groups were compared to a reference group of stable patients. Subsequent analysis assessed the association between cardiovascular characteristics and longitudinal SD-OCT or HVF progression.

OUTCOME MEASURES: Baseline and longitudinal SD-OCT and HVF progression.

RESULTS: After accounting for age and cardiovascular characteristics, patients with predominantly mGCIPL thinning at baseline had a higher prevalence of hypertension (OR: 2.70; 95% CI: [1.66, 4.41]; P<0.001), antihypertensive use (OR: 2.03; 95% CI: [1.20, 3.46]; P=0.008), and statin use (OR: 1.98, 95% CI:[ 1.07, 3.66]; P=0.029) than reference patients. Patients with predominantly pRNFL thinning did not exhibit a higher prevalence of cardiovascular disease or medications than reference patients. Review of longitudinal SD-OCT and HVF data (mean follow-up: 5.34±1.29years) showed that systemic hypertension was associated with an increased risk of SD-OCT progression (OR: 1.79; 95% CI: [1.17, 2.75]; P=0.006) and HVF progression (OR: 1.92; 95% CI: [1.18, 3.15]; P=0.013). The presence of antihypertensive treatment was associated with an increased risk of SD-OCT progression (OR: 1.83; 95%CI: [1.19,2.08]; P=0.005), and HVF conversion (OR: 1.91; 95%CI: [1.16,3.13]; P=0.010). A 1 standard deviation (∼21mmHg) increase in systolic blood pressure at baseline was associated with a greater risk of SD-OCT progression (OR: 1.27; [1.01,1.63]; P=0.041) and greater risk of HVF progression (BP OR: 1.32; 95%CI: [1.01,1.73]; P=0.043). The association between systolic blood pressure and structural progression was comparable to that observed between IOP and structural progression (OR: 1.30; 95%CI: [1.01,1.67]; P=0.039).

CONCLUSION: Cardiovascular disease is an important risk factor for mGCIPL structural change and for disease progression in glaucoma. Treatment of hypertension may be important in preventing longitudinal progression in early glaucoma.

PMID: 32730956

Clinical Paper of the Month manager: Marta Pazos