蓝/黄视野检查在预测青光眼视野变化的价值

目的　评价蓝 /黄视野检查法 (blue -on - yellow perimetry ,BYP)在预测青光眼视野缺损进展方面的价值。方法　对 1 6例原发性开角型青光眼 ( primaryopenangleglaucoma ,POAG)分别在同期内行BYP和白 /白视野检查法 (white -on -whiteperimetry ,WWP)检查 ,在同期视野检查后每年至少有 1次WWP随访检查。末次WWP检查与同期 2种视野检查的间隔时间为 1 7～ 4 0月 ,并分析WWP检查视野缺损进展情况。比较分析视野缺损进展组和未进展组的同期BYP和WWP检查的视野缺损点数和视野指数与视野缺损进展的关系。结果　 1 1例患者视野缺损无进展 ,5例患者视野缺损有不同程度的进展。进展组的BYP检查的缺损点数明显多于同期WWP检查的缺损点数 (t =4 .6 7,P =0 . 0 0 95) ;而未进展组 2种视野检查的缺损点数差异无显著性意义 (t =1 . 87,P =0. 0 91 2 ) ;BYP检查的平均敏感度 (meansensitivity ,MS)值均明显低于同期WWP检查的MS值 (P <0 . 0 5) ;BYP检查的平均缺损 (meandefect ,MD)值明显高于同期WWP检查的MD值 (P <0 . 0 5)。同期BYP和WWP视野缺损点数之比 ,进展组 ( 1 . 96± 0 .4 8)明显高于未进展组 ( 1 . 31± 0 . 4 0 ) ,两组间差异有显著性意义 (t =2 .85,P =0 . 0 1 2 9) ;同期BYP和WWP的MD值之比 ,进展     

The use of semi-automated kinetic perimetry (SKP) to monitor advanced glaucomatous visual field loss

PURPOSE: (i) To compare visual field (VF) results obtained with semi-automated kinetic perimetry (SKP) and automated static perimetry (ASP) in patients with advanced glaucomatous VF loss, (ii) to evaluate test-retest reliability of SKP and ASP and (iii) to assess patients' preference for SKP and ASP. METHODS: Twenty eyes of 20 patients (11 male, 9 female, aged 38 to 83 years) with advanced glaucomatous VF loss (stage III or IV according to the Aulhorn classification). Each of the 20 patients were examined in 4 sessions every 3 months with SKP (Goldmann stimulus III4e, I4e and at least one additional dimmer stimulus, within the 90 degrees visual field) and ASP within the 30 degrees VF, employing a threshold-related, supra-threshold test strategy with high spatial resolution for the same instrument (Octopus 101 perimeter, Haag-Streit Inc., Koeniz, Switzerland). RESULTS: Visual field areas (VFA) were compared by analyses of covariance (ANCOVA) with co-variable time, patient effect and their interaction. Test-retest reliability was assessed by ratios (R) of intersection and union of VFA: The mean VFA within the 30 degrees of VF at baseline was 2,344 square degrees (deg(2)) with SKP (Goldmann stimulus III4e) and 1,844 deg(2) with ASP. The patients showed stable visual fields for both SKP and ASP. Comparison of SKP with ASP of the same sessions revealed a median ratio of intersection and union of VFA of 0.78 with the III4e stimulus and of 0.79 with the I4e stimulus. When follow-up SKPs were compared with baseline SKPs the median of the ratios was between 0.80 and 0.93 for the different isopters. The corresponding ratio of ASP's follow-up and baseline VFs was 0.81 (with the size III static stimulus). Nineteen of 20 patients preferred kinetic perimetry to static perimetry. CONCLUSIONS: The comparability between SKP and ASP is satisfactory and within the range of the test-retest reliability of ASP. SKP shows slightly better test-retest reliability than ASP. The majority of patients with advanced glaucomatous visual field loss prefer SKP instead of ASP. SKP is a valuable alternative to ASP in monitoring advanced glaucomatous visual field loss.     

倍频视野计检测青光眼性视野缺损能力的研究

目的评估倍频视野计检测青光眼性视野缺损的能力以及与OCTOPUS101全自动视野计检查结果之间的相关性。方法应用倍频视野计的C-20—5筛选程序以及OC—TOPUS101全自动视野计的G2-TOP程序对23例正常对照者、20例早期青光眼患者、35例中晚期青光眼患者、11例高眼压患者及13例疑似青光眼患者进行视野检测。正常对照组、高眼压组及疑似青光眼组随机选择一眼进行测试，青光眼组选择具有较严重视野缺损的一眼进行测试。结果倍频视野计的C-20—5筛选程序在检测青光眼时ROC曲线下面积为0．925（敏感性85％，特异性91％），与OCTOPUS视野指数-平均缺损、偏离缺失之间的Pearson系数分别为0．702与0．429（P〈0．001），倍频视野计与OCTOPUS101视野计检查平均所需时间分别为1．00min与2．33min．2者之间有明显差异（P〈0．001）。结论倍频视野计检测青光眼性视野缺损具有良好的敏感性与特异性，与OCTOPUS101视野计的视野指数之间亦存在理想的相关性，而且前者比后者检测速度更快，使大规模人群筛查成为可能。     

Static threshold asymmetry in early glaucomatous visual field loss

Ten normal subjects underwent static threshold visual field testing of both eyes with the Humphrey perimeter, with one eye tested twice. The mean sensitivity of the field seemed virtually identical in the two eyes, with the average difference between the right and left eyes (0.65 decibels [dB]) being no greater than the testing error as reflected in the difference between the same eye tested twice (0.7 dB). The authors provide the mathematical basis for recognizing that a right eye-left eye difference in mean sensitivity might be abnormal. Additional information is needed about the variance of the right eye-left eye difference in the population at large, but present information suggests that a 2-dB difference may be meaningful on a single examination. A 1.5-dB difference is statistically significant if confirmed on a second test, and a difference as small as 1 dB may be meaningful if shown consistently in a series of four examinations. In all cases, nonglaucomatous causes of field abnormality needs to be ruled out, and the generalized asymmetry is most meaningful if it is consistent with asymmetry of cupping or intraocular pressure. Several cases are reported in which a mild (1 dB) generalized depression of the visual field is the only recognizable abnormality in the visual field in eyes with early glaucoma.     

Comparison of Humphrey MATRIX and Swedish interactive threshold algorithm standard strategy in detecting early glaucomatous visual field loss

Purpose:

The aim of this study was to compare the Humphrey MATRIX visual field (frequency doubling technology threshold) and Swedish interactive threshold algorithm (SITA) standard strategy white on white perimetry in detecting glaucomatous visual field loss.

Material and Methods:

Twenty-eight adult subjects, diagnosed to have glaucoma at a tertiary eye care hospital, who fulfilled the inclusion criteria, were included in this prospective study. All subjects underwent a complete ophthalmic examination. Subjects with glaucomatous optic disc changes underwent repeat perimetric examination on the same day with the Humphrey visual field analyzer (HFA II) and Humphrey MATRIX, the order of testing being random. Only reliable fields, where the HFA results corresponded to the disc changes were considered for analysis. A cumulative defect depth in each hemifield in both HFA and MATRIX reports was calculated.

Results:

Thirty-seven eyes of 24 subjects had reliable fields corresponding to optic disc changes. The mean age of the subjects was 56 ± 12 years. There were 12 males and 12 females. The test duration was significantly less on the MATRIX, mean difference in test duration was −81 ± 81.3 sec (p < 0.001). The mean deviation and the pattern standard deviation between the two instruments showed no significant difference (p = 0.55, p = 0.64 respectively) and a positive correlation coefficient of 0.63 and 0.72 respectively. Poor agreement was found with the glaucoma hemifield test.

Conclusion:

The Humphrey MATRIX takes less time in performing the test than SITA Standard and shows good correlation for mean deviation and pattern standard deviation. However, the glaucoma hemifield test showed poor agreement. The Humphrey MATRIX diagnoses were similar to established perimetric standards.     

A new diffuse loss index for estimating general glaucomatous visual field depression

Experience with a number of visual fields has shown that the algorithm used earlier for estimating general depression in glaucomatous visual fields was too conservative. A new, more sophisticated algorithm for calculating diffuse loss has been devised and the results obtained in the evaluation of 20 glaucomatous visual fields were compared with those obtained manually. The new algorithm is less restrictive, yet produces values for diffuse loss which agree well with the empirical estimates (R = 0.97, N = 14). The new diffuse loss index is also compared with the mean defect index (R = 0.77, N = 159), the 18th Bebie curve ranked value (R = 0.87, N = 159), and the previous diffuse loss index (R = 0.98, N = 105). A general discussion of various aspects of diffuse loss is included.Abbreviations CLV corrected loss variance - DLS differential light sensitivity - DLN new diffuse loss index - DLO old diffuse loss index - DLE diffuse loss obtained by inspection - L18 loss at 18th ranked location - MD mean defect     

早期青光眼患者普通與藍、黄視野值的比較分析

目的為藍黄視野計在開角型青光眼早期診斷方面的作用提供先導分析.方法對17例(27眼)早期青光眼患者分别采用普通與藍黄視野計進行視野檢查,并對其相應的值作統針學比較分析.結果普通視野計與藍黄視野計對早期青光眼的檢查結果有高度統計學差异(P＜0.01),藍黄視野在診斷早期青光眼時更敏感.結論藍黄視野分析是一種可靠、準確、簡便,更適合早期青光眼診斷的方法.     

Comparison of retinal nerve fibre layer thickness with visual evoked potential and visual field in patients with multiple sclerosis

Background: To evaluate retinal nerve fibre layer thickness and to compare results with visual evoked potentials and visual field in patients with multiple sclerosis. Design: A prospective, case‐control study, university hospital setting. Participants: Seventy‐three eyes of 37 multiple sclerosis patients and 74 eyes of 37 healthy subjects. Methods: All patients underwent a complete neurological and ophthalmological examination and peri‐papillary retinal nerve fibre layer thickness was evaluated using scanning laser polarimetry (GDx). Furthermore, visual evoked potential and visual field testing were performed. Main Outcome Measures: The χ² test, Student's t‐test, Mann–Whitney U‐test and Pearson's correlation coefficient analysis of the GDx, visual evoked potential and visual field testing parameters. Results: GDx measurements showed significantly more retinal nerve fibre layer damage in the patients than in the control groups. Comparison of the GDx parameters between patients with optic neuritis and non‐optic neuritis demonstrated a statistically significant difference in symmetry (P = 0.046) and superior/nasal parameters (P = 0.009). A correlation was found between the number, superior and inferior ratio parameters, and P100 amplitude obtained with visual evoked potential in patients with non‐optic neuritis. Additionally, there was a correlation between the number, inferior ratio and superior/nasal parameters, and the mean deviation of visual field in the non‐optic neuritis group. Conclusions: For retinal nerve fibre layer thickness measurements in multiple sclerosis patients, the GDx, along with other techniques, such as visual evoked potential, can be used as a diagnostic and follow‐up criterion, particularly in patients without optic neuritis.     

偏振激光扫描仪联合个体化角膜补偿技术对可疑青光眼的随访研究

目的 对临床可疑青光眼患者进行长期的偏振激光扫描仪联合个体化角膜补偿技术(scanning laser polarimetry with variable corneal compensation, GDx VCC)随访,分析GDx VCC对该类患者的诊断价值.方法 选取门诊可疑青光眼的眼底检查视乳头杯/盘比(C/D)≥0.4,或双眼不对称且C/D差值≥0.2,静态视野检查结果正常患者68例,随访前后均用GDx VCC检查(采用相同的角膜补偿值).如双眼C/D值相同,随机选取1眼,如C/D值不同,则选取C/D值大的1眼,对结果进行t检验统计学分析.结果 随访时间6～30个月,平均(12.5±7.0)个月,眼底C/D值为 0.57±0.17.随访前后GDx VCC 检查:椭圆平均值分别为50.33±7.72和49.66±8.12,上方平均值为58.72±13.56和58.18±12.01,下方平均值为60.71±11.31和59.13±11.95,神经纤维指数为30.85±19.62和33.03±21.22,差异无统计学意义,但从绝对数值上,椭圆平均值、上方平均值和下方平均值变小,神经纤维指数变大.其中7例(10.3%)诊断为青光眼, 21例(30.9%)排除青光眼,40例(58.8%)仍需进一步随访.结论 对临床怀疑青光眼的患者应长期进行随访,GDx VCC随访对青光眼的诊断有一定的价值.(中国眼耳鼻喉科杂志,2009,9:92-94)     

频域OCT对正常人和青光眼光感受器细胞层厚度的检测

背景青光眼以视网膜内层的神经节细胞丢失为主要病理特征,但其是否累及视网膜外层尚有争议。部分研究认为青光眼将导致视网膜外层（光感受器）功能的异常,而病理学研究得出了不同的结论。目的用频域OCT测量正常人和青光眼患者光感受器细胞层的厚度,探讨青光眼对光感受器细胞层厚度的影响。方法采用病例对照研究。用频域OCT（SDOCT）对正常人38例38眼和青光眼患者48例48眼的黄斑区进行扫描,由一位检测者采用Sigma图像分析软件盲法测量黄斑中心凹和旁中心凹处（中心凹外1．5mm）视网膜光感受器层的厚度。同时采用时域OCT（Stratus OCT）测量所有检测眼的视盘周围视网膜神经纤维层（RNFL）厚度,比较正常组和青光眼组光感受器细胞核层的平均厚度,分析光感受器细胞层厚度与RNFL厚度的关系。结果正常组和青光眼组在黄斑中心凹光感受器细胞核层厚度分别是（96．7±10．7）μm、（103．7±13．3）μm,差异有统计学意义（P=0．011）;中心凹光感受器内节和外节层厚度分别是（59．3±5．5）μm、（59．5±5．5）μm,差异无统计学意义（P=0．890）。正常组和青光眼组在中心凹外3mm处光感受器细胞核层厚度分别是（70．9±14．0）μm、（68．7±10．7）μm,光感受器内节和外节层厚度分别为（45．2±6．4）μm,（43．6±5．5）μm,差异均无统计学意义（P=0．410,P=0．228）。黄斑中心凹处光感受器细胞核层厚度和RNFL厚度两者有二元线性关系（γ=-0．019X。＋2．73X＋10．34,R^2=0．211,P=0．005）。结论青光眼的黄斑中心凹光感受器细胞核层显著增厚,并随病程的变化而改变。     

Optic disc cup slope and visual field indices in normal, ocular hypertensive and early glaucomatous eyes

AIM: To evaluate the correlation between internal slope analysis of the optic nerve head and visual field changes in normal eyes and those with ocular hypertension (OHT) and early glaucoma (POAG). METHODS: One eye of each of 22 normal subjects, 21 patients with ocular hypertension, and 50 patients with glaucoma were examined using the TopSS scanning laser ophthalmoscope. A series of topographic parameters measuring the internal features of the optic discs of these patients were obtained. These findings were compared with the Humphrey visual field analysis of these patients. RESULTS: Global topographic average slope and cup to disc ratio could discriminate between groups of normal and OHT patients (p = 0.02). All global and sector analysis parameters could discriminate normal subjects from POAG patients. The average slope parameter provided the best separation with a receiver operating characteristic curve area of 0.88. Visual field mean deviation (MD) was most closely correlated with global average slope (r = -0.60, p<10(-7)) and cup to disc ratio (r = -0.40, p<0.001). Visual field MD was also well correlated (r = -0.50, p<0.0001) with slope parameters for sectors S8, S2, and S1. CONCLUSION: Average slope, a parameter independent of reference planes and magnification effects, is capable of discriminating groups of OHT and POAG patients from a group of normal subjects. This topographic parameter is also well correlated with the visual field MD. Sector slope analysis suggests early glaucomatous damage may occur in the inferotemporal region of the optic disc.     

Discrimination between normal and glaucomatous eyes with visual field and scanning laser polarimetry measurements

AIM: To evaluate the ability of structural parameters (as determined by retinal nerve fibre layer (RNFL) measurements obtained with the scanning laser polarimeter (SLP-NFA/GDx)) and functional parameters (as determined by automated perimetry) to discriminate between normal and glaucomatous eyes. METHODS: In a case-control study, a total of 91 normal subjects and 94 patients with glaucoma underwent automated perimetry and RNFL measurements obtained with the SLP. Three independent scans of each eye were obtained and a mean image was created and used for further analysis. Only one eye per individual was randomly included in the study. The sensitivity (Se) and specificity (Sp) of 12 RNFL parameters were calculated according to the SLP internal normative database. The Se and Sp of the visual field (VF) global indices and the glaucoma hemifield test (GHT) were also calculated according to the instrument's normative database. Receiver operator characteristic (ROC) curves were built for each SLP parameter and VF index. Fisher's linear discriminant formulas (LDFs) were developed for VF indices (VF LDF), SLP measurements (SLP LDF), and both examinations (combined LDF). RESULTS: According to the SLP internal database, the parameters with better Se and Sp were: superior/nasal ratio (Se = 58.5%; Sp = 86.8%), and GDx the number (Se = 43.3%; Sp = 96.7%). The construction of an ROC curve for the number resulted in Se = 84% and Sp = 79%. The creation of LDFs improved both the sensitivities and specificities when compared with isolated parameters SLP LDF (Se = 90.4%; Sp = 82.4%), VF LDF (Se = 89.4%; Sp = 89.0%), and combined LDF (Se = 93.0%; Sp = 90.1%). The sensitivity to diagnose early and moderate glaucomatous damage observed with the GHT was lower than that obtained with the number (p < 0.01). CONCLUSIONS: Creation of LDFs enhanced the Se and Sp for both VF and SLP. Integration of SLP and VF in a combined LDF reached the highest Se/Sp relation, suggesting that these examinations may be additive concerning the diagnosis of glaucoma. The SLP parameter the number may be more sensitive than the GHT in diagnosing early and moderate glaucomatous damage.     

单侧青光眼视野缺损患者假阴性反应的眼间差异

目的 探讨单侧青光眼视野缺损患者电脑视野检查假阴性反应率的眼间差异及相关因素。方法 选取2000年1月～2002年10月在青岛大学医学院附属医院眼科视野检查室行Octopus101自动静态视野检查的单侧青光眼视野缺损患者66例进行研究；比较患者眼间视力、眼压、杯盘比、检查时间及假阴性反应率、假阳性反应率、平均偏差、平均光敏感度的差异，并分析假阴性反应率的相关因素。结果 视野缺损眼与视野正常眼的假阴性反应率(FN)差异显著，且与检查的先后顺序无关，而两眼在视力、眼压、瞳孔直径等方面无明显差异；视野缺损眼平均偏差(MD)与FN相关，在MD越高的眼，FN越高；而正常眼MD与FN无关。结论 假阴性反应率可能与视野缺损有关；用假阴性反应率作为可靠性指数来监测受检者的专心程度、注意力集中程度，是不合适的。     

Patterns of visual loss associated with pituitary macroadenomas

Purpose: To describe the patterns of visual loss associated with pituitary macroadenomas compressing the anterior visual pathway.
Method: A prospective survey of 29 patients with pituitary macroadenomas who presented to the neurosurgical unit at St Vincent's Hospital, Melbourne. Selected patients had histologically verified pituitary macroadenomas, and visual defects (acuity, colour and/or field loss) consistent with anterior visual pathway compression.
Results: All patients had visual field defects detected on perimetry, and the majority were asymmetrical. Bitemporal defects were most common but field defects ranged from monocular defects to generalised constriction. Four patients (13.8%) did not report visual symptoms, and of those who had symptoms, blurred vision was the most common complaint. Ninety-six per cent of eyes had field loss, 56% had decreased colour vision, 46% had decreased acuity, 31% had optic disc pallor, and 2% had an ophthalmoplegia.
Conclusions: Patients with visual pathway compression by pituitary macroadenomas may be asymptomatic despite having field defects. Perimetry is the most sensitive method of identifying compression, followed by colour vision, visual acuity, then the presence of optic atrophy. Automated static threshold perimetry appears to show early field defects better than manual kinetic perimetry. All patients with pituitary macroadenomas should have thorough ophthalmological examinations, including perimetry to document visual deficits secondary to compression.     

The influence of oral statin medications on progression of glaucomatous visual field loss: A propensity score analysis

Purpose: The purpose of this study was to examine the association between oral statin use and the progression of open angle glaucoma.

Methods: Medical records of 847 Veterans were reviewed to collect statin use history, record demographic and comorbid medical conditions, and review visual fields. Visual field progression was judged by an ophthalmologist masked to statin use history. Progression rates in a propensity score matched cohort were compared between statin users and nonusers using McNemar’s test with the propensity model derived using associated medical and demographic factors.

Results: The mean length of observation was 1324 days with a standard deviation of 464 days. Thirty-one per cent of Veterans demonstrated glaucomatous progression in at least one eye, 49% did not demonstrate progression, and 20% were indeterminate. Approximately 74% of subjects had previously used a statin, with this group having heavier burdens of several comorbid medical conditions and less severe baseline glaucoma than nonusers. The matched cohort was 196 statin users and 196 nonusers, each with similar baseline characteristics (standardised differences <0.10). Progression rates were 35% for statin users compared to 56% for nonusers in the matched cohort (McNemar’s p<0.001).

Conclusions: In this population of Veterans, glaucoma patients with any history of statin use have lower visual field progression rates than statin nonusers.     

Long-term studies of visual field changes by means of computerized perimetry (Octopus 201) in eyes with glaucomatous field defects after normalization of the intra-ocular pressure

126 eyes with open-angle glaucoma and defects of the visual field were studied over five years (±1.3) by repeated perimetries with Octopus Perimeter, Program 31, after the IOP had been normalized from 26.49 mm Hg to 19 mm Hg.All patients had suffered visual field defects in the period with increased pressure preceeding our study and had many perimetric examinations before. The aim of the study was to check the behaviour of the visual field defects after pressure normalization.For evaluation of the visual fields, the upper most line of the test-points and the 6 test-points surrounding the blind spot were disregarded. The evaluation of each field and the comparison with preceding fields (no change, better, or worse) were done by the symmetry test of Bowker instead of the Delta Program, taking into account each of the 61 test-points with a significance level of 5%. In each patient the eye with the heavier field loss was evaluated.Results: 67% of all eyes had no change during the observation time, 12% became better, and 21% worse. Improvement of the visual fields occurred even in old age: 10% became better in the age-group over 70 years. The total loss decreased in the 15 eyes which improved by 269 dB. In eyes which deteriorated, the total loss increased by 282 dB.The good news of this study is that normalization of IOP can stop the further decay of the visualfield in 67% and an improvement of the field loos is possible even in old age of with heavy field loss.Finally, the case of a 14 years old boy is reported who had late developmental glaucoma and who improved from a total loos of 1200 dB in his only eye of 500 dB after his IOP was normalized.     

Comparison of confocal scanning laser ophthalmoscopy, scanning laser polarimetry and optical coherence tomography to discriminate ocular hypertension and glaucoma at an early stage

Background The aim was to compare the ability of confocal scanning laser ophthalmoscopy (CSLO), scanning laser polarimetry (SLP), and optical coherence tomography (OCT) to discriminate eyes with ocular hypertension (OHT), glaucoma-suspect eyes (GS) or early glaucomatous eyes (EG) from normal eyes. Methods Ocular hypertension, GS, and EG were defined as normal disc with intraocular pressure >21 mmHg, glaucomatous disc without visual field loss, and glaucomatous disc accompanying the early glaucomatous visual filed loss respectively. Ninety-three normal eyes, 26 OHT, 55 GS, and 67 EG were enrolled. Optic disc configuration was analyzed by CSLO (version 3.04), whereas retinal nerve fiber layer thickness was analyzed by SLP (GDx-VCC; version 5.3.2) and OCT-1 (version A6X1) in each individual. The measurements were compared in the four groups of patients. Receiver operating characteristic curve (ROC) and area under the curve (AUC) discriminating OHT, GS or EG from normal eyes were compared for the three instruments. Results Most parameters in GS and EG eyes showed significant differences compared with normal eyes. However, there were few significant differences between normal and OHT eyes. No significant differences were observed in AUCs between SLP and OCT. In EG eyes, the greatest AUC parameter in OCT (inferior—120; 0.932) had a higher AUC than that in CSLO (vertical cup/disc ratio; 0.845; P=0.017). In GS, the greatest AUC parameter in OCT (average retinal nerve fiber layer [RNFL] thickness; 0.869; P=0.002) and SLP (nerve fiber indicator [NFI]; 0.875; P=0.002) had higher AUC than that in CSLO (vertical cup/disc ratio; 0.720). Conclusions Three instruments were useful in identifying GS and EG eyes. For glaucomatous eyes with or without early visual field defects, SLP and OCT performed similarly or had better discriminating abilities compared with CSLO.     

Diurnal IOP fluctuation: not an independent risk factor for glaucomatous visual field loss in high-risk ocular hypertension

Purpose To establish whether intraocular pressure (IOP) fluctuations contribute to the risk of developing glaucoma in patients with high-risk ocular hypertension.Methods Ninety patients included in the Malmö Ocular Hypertension Study were examined every 3 months with office-hours diurnal tension curves and computerised perimetry. Patients were followed up prospectively for 10 years or until glaucomatous visual field loss could be demonstrated. Poststudy data were included in the analyses, extending maximum follow-up to 17 years.Results After 17 years, 37 patients had developed glaucomatous visual field defects. When applying univariate Cox regression analyses, mean IOP of all measurements during the prospective part of the study was a significant risk factor for developing glaucoma (95% confidence interval [CI] 1.08–1.39), while IOP fluctuations were almost significant (95% CI 0.98–1.93). When separating effects of mean IOP level and mean IOP fluctuation using Cox multiple regression analysis, only IOP level came out as significant (95% CI 1.09–1.38), and IOP fluctuations did not contribute to the risk (95% CI 0.80–1.60). IOP fluctuation depended linearly on IOP level (p<0.0001), i.e. IOP fluctuation was larger in eyes with higher IOP levels.Conclusion IOP fluctuations were not an independent risk factor for the incidence of glaucomatous visual field loss in subjects with ocular hypertension.