Intraocular pressure and progression of glaucomatous visual field loss

PURPOSE: To evaluate the relationship between intraocular pressure and visual field progression in patients with primary open-angle glaucoma. METHODS: We prospectively followed 113 patients with early to moderate glaucomatous field damage. Conventional automated static perimetry, high-pass resolution perimetry, and intraocular pressure measurements were carried out at 6-month intervals. The mean and the highest intraocular pressure in the follow-up were compared in stable and progressing patients with each perimetric technique. RESULTS: The mean (± SD) follow-up was 4.5 ± 0.9 years. The mean (± SD) intraocular pressure in patients remaining stable with conventional perimetry [18.2 ± 3.3 mm Hg, n = 81 (71.7%)] was not significantly different ( P =.65) from those in whom it progressed (17.9 ± 3.3 mm Hg, n = 32 [28.3%]). The mean intraocular pressure in patients remaining stable with high-pass resolution perimetry (17.9 ± 3.5 mm Hg, n = 63 [55.8%]) was not significantly different ( P = .33) from those in whom it progressed (18.5 ± 3.0 mm Hg, n = 50 [44.2%]). The mean (± SD) of the highest (single or three highest) pressure during follow-up for stable and progressing patients with conventional perimetry was not significantly different (22.6 ± 5.0 and 23.0 ± 4.6 mm Hg, respectively, P = .76). However, for high-pass resolution perimetry, the difference was highly significant (21.6 ± 4.5 and 24.1 ± 4.9 mm Hg, respectively, P < .01). Furthermore, patients who progressed with high-pass resolution perimetry had more damaged baseline fields compared with those who remained stable ( P < .01). CONCLUSIONS: The mean level of intraocular pressure does not differentiate glaucoma patients with progressive visual field loss from ones who remained stable. Baseline visual field status and peak intraocular pressure of patients who progress with high-pass resolution perimetry are significantly different from those who remain stable.