Long-term scanning laser ophthalmoscopy and perimetry in different severities of primary open and chronic angle closure glaucoma eyes

PURPOSE: To determine rate of change over time on scanning laser ophthalmoscopy, HRT, compared to perimetry, and to determine incidence, parametric changes, and risk factors for progression in primary open angle glaucoma (POAG) and chronic primary angle closure angle glaucoma (CPACG) eyes. METHODS: Prospective clinical study of 116 POAG eyes and 129 CPACG eyes of different severities of glaucoma. Standard automated perimetry and optic nerve head topography were studied at baseline and thereafter every 6 months. Changes in HFA and HRT parameters, in response to IOP, were compared over at least 5 years. RESULTS: Fourteen POAG eyes (12.1%) and 20 CPACG eyes (15.5%) showed progression on SAP over time. Percentage drop of IOP was similar in eyes that progressed and in stable eyes. The change in MD in CPACG eyes was 1.8 dB/year on SAP and 1.36 dB/year in POAG eyes, P = 0.1. Twenty-nine eyes showed progression on HRT with 24 confirmed on SAP. Trend analysis picked up progression more frequently than other HRT parameters. Eyes that progressed in both groups, in all severities of glaucoma, had intermittent fluctuations of ≥ 4 mmHg over mean IOP on ≥3 follow up visits, P ≤ 0.001. CONCLUSION: IOP fluctuations of ≥ 4 mmHg over the mean IOP and duration of disease were associated with progression in POAG and CPACG eyes.