Optic Disc Rotation as a Clue for Predicting Visual Field Progression in Myopic Normal-Tension Glaucoma

Purpose: To investigate factors associated with visual field (VF) progression in myopic normal-tension glaucoma (NTG) and to determine the relationship between optic disc rotation and VF progression. Design: Retrospective, observational study. Subjects: Ninety-two patients with myopic NTG, with VF loss confined to a single hemifield, who were followed up over a 2-year period. Methods: Systemic and ocular findings such as optic disc tilt and optic disc rotation were evaluated. The eyes with optic disc rotation accompanying a corresponding VF defect were defined as those with correspondence. Visual field progression was defined by Early Manifest Glaucoma Trial criteria. The Cox proportional hazards model was used to determine the risk factors for VF progression. Main Outcome Measures: Progression of VF. Results: The mean age of subjects was 37.83 +/- 10.89 years, mean spherical equivalent refractive error was -5.51 +/- 3.37 diopters, and mean axial length was 26.18 +/- 1.79 mm. Mean follow-up duration was 55.78 +/- 30.12 months. Among 92 eyes, 37 showed VF progression. A multivariate Cox proportional hazard model revealed that percentage reduction in intraocular pressure (IOP) from baseline (hazard ratio [HR], 0.965; P = 0.013), optic disc hemorrhage (HR, 2.623; P = 0.019), and optic disc rotation-VF defect correspondence (HR, 0.441; P = 0.016) were associated with VF progression in myopic NTG eyes. Conclusions: In addition to the percentage reduction in IOP from baseline and optic disc hemorrhage, optic disc rotation-VF defect correspondence may be an important prognostic factor for patients with myopic NTG. (C) 2016 by the American Academy of Ophthalmology.