Anderson Douglas R
Department of Opthalmology, University of Miami School of Medicine, Miami, Florida 33101-6880, USA.
Curr Opin Ophthalmol. 2003 Apr;14(2):86-90. doi: 10.1097/00055735-200304000-00006.
Before this study was done, there was a difference of opinion concerning whether intraocular pressure (IOP) was involved in producing optic nerve damage when there was glaucomatous damage to the optic nerve and characteristic visual field loss, even though the IOP was in the statistically normal range. This article reviews the findings of a collaborative study aimed at finding the answer to this question.
The level of pressure influences the course of normal tension glaucoma, as evidenced by a slower rate of incident visual field loss in cases with 30% or more lowering of intraocular pressure. The rate of progression without treatment is highly variable, but often slow enough that half of the patients have no progression in 5 years. A faster rate occurs in women, in patients with migraine headaches, and in the presence of disc hemorrhages. Some patients may experience greater benefit from lowering of IOP than others, but further research is needed to be able to identify those most likely to benefit.
As a group, patients with normal tension glaucoma benefit from lowering of IOP. Variable rate of deterioration, as well as lack of progression in a substantial number in 5 years, suggest that treatment should be individualized according to the stage of disease and rate of progression. Traits that help predict risk and rate of progression and response to treatment are beginning to become known and, when fully known, will help guide management decisions.
在本研究开展之前，对于青光眼性视神经损害及特征性视野缺损时，即使眼压在统计学正常范围内，眼压是否参与视神经损害的发生存在不同观点。本文综述了一项旨在回答该问题的合作研究结果。
眼压水平影响正常眼压性青光眼的病程，眼压降低30%或更多的病例中视野缺损发生率较低即证明了这一点。未经治疗时病情进展速度差异很大，但通常足够缓慢，以至于一半的患者在5年内病情无进展。女性、有偏头痛的患者以及存在视盘出血时病情进展更快。一些患者降低眼压可能比其他患者获益更大，但需要进一步研究以确定最可能获益的患者。
总体而言，正常眼压性青光眼患者可从降低眼压中获益。病情恶化速度各异，且相当数量的患者在5年内病情无进展，这表明应根据疾病阶段和进展速度进行个体化治疗。有助于预测风险、进展速度及治疗反应的特征开始为人所知，一旦完全明确，将有助于指导治疗决策。
