Correlation of pattern reversal visual evoked potential parameters with the pattern standard deviation in primary open angle glaucoma

AIM:To evaluate whether glaucomatous visual field defect particularly the pattern standard deviation(PSD)of Humphrey visual field could be associated with visual evoked potential(VEP)parameters of patients having primary open angle glaucoma(POAG).METHODS:Visual field by Humphrey perimetry and simultaneous recordings of pattern reversal visual evoked potential(PRVEP)were assessed in 100 patients with POAG.The stimulus configuration for VEP recordings consisted of the transient pattern reversal method in which a black and white checker board pattern was generated(full field)and displayed on VEP monitor(colour 14')by an electronic pattern regenerator inbuilt in an evoked potential recorder(RMS EMG EP MARK II).RESULTS:The results of our study indicate that there is a highly significant(P【0.001)negative correlation of P100 amplitude and a statistically significant(P【0.05)positive correlation of N70 latency,P100 latency and N155 latency with the PSD of Humphrey visual field in the subjects of POAG in various age groups as evaluated by Student’s t-test.CONCLUSION:Prolongation of VEP latencies were mirrored by a corresponding increase of PSD values.Conversely,as PSD increases the magnitude of VEP excursions were found to be diminished.

Study of long term structural and functional changes in medically controlled glaucoma

AIM: Prospectively analyze the long term structural and functional changes in patients of primary open angle glaucoma(POAG) receiving medical therapy(beta blockers and non beta blockers). In this study an attempt has been made to evaluate whether medical reduction of IOP prevents or delays the progression of glaucomatous visual field loss and/or optic nerve damage in patients with open angle glaucoma. · METHODS: Study conducted over a period of 27 months,at a tertiary eye care hospital including both eyes of 40 patients with POAG. Group 1(20 patients,40 eyes) received beta-blockers,and Group 2(20 patients,40 eyes) received non-beta-blockers. Each patient underwent intraocular pressure measurement,best corrected visual acuity,slit-lamp,fundus examination,gonioscopy,central corneal thickness,visual field assessment by Humphrey automated perimetry and retinal nerve fibre layer thickness by Stratus optical coherence tomography at baseline and at two subsequent visits. The average time interval between each visit was 10-11 months. The statistical analysis was done using one-way analysis of variance(ANOVA). Post-hoc test,using tukey’ method were adopted. Probablity(P) value of 0.05 or less was considered to be statistically significant. ·RESULTS: A total of 80 eyes of 40 patients of POAG were enrolled,24 males,16 females,age group 50-80 years. In both beta and non beta blocker group,reduction(improvement) in mean IOP from initial levels to the levels achieved at the 2nd and 3rd visits was statistically significant. One way ANOVA(df=2),fisher f value =11.64,P =0.000,one way ANOVA(df =3),fisher f value =35.61,P =0.000. Both mean deviation(MD) and pattern standard deviation(PSD) in both beta and nonbeta blockers at different visits were not statistically significant. Retinal nerve fibre layer thickness(RNFL)-only mean inferior retinal nerve fibre layer,the difference between the mean value in beta and non beta blocker groupwere statistically significant. [unpaired t test value(df =78) =2.27,P =0.03]. Side effects with beta blocker were conjunctival hyperemia(10%),burning(5%),and conjunctival hyperemia(5%) in non beta blockers. ·CONCLUSION: Non-beta-blockers are as effective as beta-blockers in bringing about a significant lowering of intraocular pressure to the normal range,and in preventing progressive damage to the visual fields and retinal nerve fibre layer. The absence of systemic side effects and superior IOP lowering efficacy has made non beta-blockers attractive for first line therapy for the treatment of glaucoma worldwide.