THE PROGRESS OF THE VISUAL-FIELD IN CHRONIC SIMPLE GLAUCOMA AND OCULAR HYPERTENSION TREATED TOPICALLY WITH PILOCARPINE OR WITH TIMOLOL

It is theoretically possible that the vascular effects of topical sympathetic beta-blocking therapy in chronic simple glaucoma (CSG) might tend to neutralise the beneficial effect of a reduced intraocular pressure on the preservation of the visual field. We therefore followed the progress of 422 right eyes and 420 left eyes of 483 patients with CSG and 119 right eyes and 132 left eyes of 151 patients with an original diagnosis of ocular hypertension (OH). These patients were observed for a minimum of one year and up to 13 years, being followed for an average period of 5.1 years in the case of CSG and of 4.5 years in OH. The majority of eyes with CSG were treated topically with a miotic and 38% of these received beta blocking therapy in the form of topical timolol. It was concluded that despite suggestions that beta blockers might reduce vascular perfusion of the optic nerve head, which might in turn cause an adverse effect on the visual field progress, the results of this analysis showed that there was less mean deterioration of visual field in eyes treated with beta blocker plus miotic treatment compared with those on miotic therapy alone.