Cardiovascular Disease Predicts Structural and Functional Progression in Early Glaucoma

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

Design: Prospective, longitudinal study of preperimetric and perimetric glaucoma.

Participants: Two thousand six hundred twenty-eight 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 using spectral-domain OCT and for visual field progression on Humphrey visual field (HVF) assessment.

Methods: Patients were classified as either predominantly macula ganglion celleinner plexiform layer (mGCIPL), predominantly peripapillary retinal nerve fiber layer (pRNFL), or both mGCIPL and pRNFL structural change at enrollment, and then evaluated for longitudinal OCT or HVF progression. Cardiovascular disease and medication characteristics of the participants were compared with a reference group of stable patients.

Main Outcome Measures: OCT and HVF baseline status and longitudinal progression.

Results: After accounting for age and cardiovascular characteristics, patients with predominantly mGCIPL thinning at baseline showed a higher prevalence of hypertension (odds ratio [OR], 2.70; 95% confidence interval [CI], 1.66e4.41; P < 0.001), antihypertensive use (OR, 2.03; 95% CI, 1.20e3.46; P ¼ 0.008), and statin use (OR, 1.98; 95% CI, 1.07e3.66; P ¼ 0.029) than reference patients. Patients with predominantly pRNFL thinning exhibited a comparable prevalence of cardiovascular disease or medication with reference patients. Review of longitudinal OCT and HVF data (mean follow-up, 5.34  1.29 years) showed that hypertension was associated with an increased risk of both OCT (OR, 1.79; 95% CI, 1.17e2.75; P ¼ 0.006) and HVF progression (OR, 1.92; 95% CI, 1.18e3.15; P ¼ 0.013). A 1-standard deviation (approximately 21 mmHg) increase in systolic blood pressure at baseline was associated with a greater risk of OCT progression (OR, 1.27; 95% CI, 1.01e1.63; P ¼ 0.041) and HVF progression (OR, 1.32; 95% CI, 1.01e1.73; P ¼ 0.043). The association between systolic blood pressure and structural progression was comparable to that observed between intraocular pressure and structural progression (OR, 1.30; 95% CI, 1.01e1.67; P ¼ 0.039).

Conclusions: Cardiovascular disease is an important risk factor for glaucoma progression. Ophthalmology 2021;128:58-69 Crown Copyright ª 2020 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology