Reversal of optic disc cupping in glaucoma

Aim: To study whether reversal of optic disc cupping after intraocular pressure (IOP) reduction is related to risk of glaucoma progression. Methods: In this prospective follow-up study, where 51 patients with exfoliation glaucoma and five with ocular hypertension combined with exfoliation syndrome were followed for 6 years after IOP reduction, 24 showed progression of glaucoma in visual fields or optic nerve head (ONH) stereophotographs. ONH topography was measured with the Heidelberg Retina Tomograph (HRT). A decrease in HRT parameter cup volume of more than 5% was considered cup reversal. Multiple logistic regression was used to model progression of glaucoma. Results: Cup reversal ( OR 0.226; 95% CI 0.055 to 0.918, p= 0.037), final IOP ( OR 1.216; 95% CI 1.000 to 1.479, p= 0.050) and visual field mean defect at entry (OR 1.158; 95% CI 1.034 to 1.296, p= 0.011) were associated with progression. IOP change from study entry to 6-year control visit was not associated with progression (OR 0.964, 95% CI 0.850 to 1.092, p= 0.56). Conclusion: Cup reversal seemed to be an independent protective factor for progression of glaucoma.