Comparison of visual field progression between temporally tilted disc and nontilted disc, in patients with normal tension glaucoma.

Purpose: To investigate the long-term visual field (VF) progression of temporally tilted disc and nontilted disc in normal tension glaucoma (NTG).

Methods: Retrospective, observational case series. Forty-seven patients with temporally tilted disc (47 eyes), 44 patients with nontilted disc in NTG (44 eyes) patients, who were examined by at least 5 VF tests, and were followed-up over a 5-year period, at the Department of Ophthalmology of the Samsung Medical Center, from May 1998 to 2013. VF progression was defined by modified Anderson-Hodapp criteria, and Glaucoma Progression Analysis (GPA). Multivariate analysis was used to identify the risk factors for VF progression in the temporally tilted disc.

Results: According to the Anderson-Hodapp criteria, progression rates of the temporally tilted disc and nontilted disc at 60 months were 19% and 72%, respectively (P<0.0001). According to GPA, they were 25% and 53%, respectively (P<0.0001). Twenty of 47 patients in the temporally tilted disc did not show progression. Among them, the more tilted disc showed the more VF defects. The hazard ratio of retinal nerve fiber layer (RNFL) defect type was 3.08 (95% CI, 1.17-8.14; P=0.02). The simultaneous superior and inferior RNFL defect type was the most common in progressors in the temporally tilted disc (P=0.04).

Conclusion: Through long-term follow-up, the cumulative survival rate of temporally tilted disc was higher than that of nontilted disc. Caution is required in the treatment of the temporally tilted disc. New treatment policy for the temporally tilted disc may follow.