Clinical Course and Risk Factors for Visual Field Progression in Normal-Tension Glaucoma With Myopia Without Glaucoma Medications

Purpose: To investigate the natural clinical course and the risk factors of visual field (VF) progression in untreated normal-tension glaucoma (NTG) with myopia with a minimum 3-year follow-up. Design: Retrospective cohort study. Methods: Kaplan-Meier survival analysis and log-rank test were used to compare survival experiences between the groups. The hazard ratios (HRs) for the associations between potential risk factors and glaucomatous progression were determined using Cox proportional hazards model. Results: The average follow-up period for the included 97 patients was 71.1 ± 29.7 months and 32 eyes showed progression during the observation period. In NTG with myopia, Kaplan-Meier survival curve showed progression cases in 10.3% at 36 months and 24.8% at 60 months. When age and disc tilt direction were classified into 2 groups, a higher cumulative probability of progression was observed in those aged ≤50 years than >50 years (P = .001) and in those with disc tilt direction <45 degrees than disc tilt direction ≥45 degrees (P = .002). In Cox proportional hazards model, younger age, presence of disc hemorrhage, and more temporally tilted disc or parapapillary atrophy were associated with progression. Conclusions: NTG with myopia seems to have a slow progression rate even without glaucoma medications. Only 10.3% and 24.8% of patients showed VF progression at 3 years and 5 years of follow-up in untreated NTG with myopia. To predict VF progression in untreated NTG with myopia, it seems that age and disc morphology should be considered.