Cup reversal protects from glaucoma progression

Abstract Purpose: Reversal of optic disc cupping after reduction in intraocular pressure (IOP) is well documented. The effect of cup reversal on the risk of progression of glaucoma was investigated. Methods: All 80 consecutive patients referred to the Helsinki University Eye Hospital between May 1995 and May 1997 because of exfoliation glaucoma were included. They were treated medically, with laser trabeculoplasty, or surgically. Fifty‐six patients (mean age ±SD at study entry, 70 ± 7 years) were followed for 5.9 ± 0.8 years. Scanning laser opthtalmoscopy (Heidelberg Retina Tomograph, HRT) of the optic nerve head was performed before treatment and at follow up visits. A decrease of more than 5% in the HRT parameter cup volume (CV) after change in treatment was considered to be a sign of cup reversal. The effect of cup reversal on progression of glaucoma was modelled in multiple logistic regression. Results: Of 56 patients, 24 showed progression of glaucoma in visual fields or optic discs. The other 32 remained stable. IOP reduced from 21 ± 5 mmHg to 16 ± 4 mmHg (P < 0.001). Presence of cup reversal was related to decreased risk of progression of glaucoma (Odds ratio [OR], 0.226; 95% CI, 0.055‐0.917, P = 0.037). The risk of progression increased with higher MD at study entry (OR, 1.158 for each dB; 95% CI, 1.034‐1.296; P = 0.011), and higher final IOP (OR, 1.216 for each mmHg; 95% CI, 1.000‐1.479; P = 0.050). The change in IOP from study entry to final IOP was not associted with progressio progression (OR, 0.964 for each mmHg; 95% CI, 0.850‐1.092, P = 0.561). Conclusions: Optic disc cupping can be reversed and sustained for years after IOP reduction. Cup reversal seemed to be an independent protective factor against progression of glaucoma.