Macular Damage in Early Glaucoma and Progression

Structural and Functional Progression of Glaucomatous Damage to the Macula

Glaucoma is the leading cause of irreversible blindness worldwide. This study aims to test a new method that may allow earlier diagnosis of glaucoma and better ways to monitor if it is getting worse. There is scientific evidence that the macula, the central part of the retina, can be involved in very early stages of glaucoma. Glaucomatous damage to the macula is very prevalent and is often missed using conventional clinical tests.

Relatively little is known about progression of early glaucoma damage and its effects on the macula. This project investigates the nature of progressive damage to the macula and proposes new methods to improve accuracy to detect clinically significant progression.The study will evaluate the nature of damage to the macula's structures through OCT imaging and eye function via visual field tests.

Study Overview

• Status: Recruiting
• Conditions: Glaucoma

Detailed Description

There is compelling evidence that glaucomatous damage to the macula occurs even in early stages of the disease. The macula comprises about 30% of all retinal ganglion cells and its information corresponds to over 50% of the visual cortex. However, glaucomatous damage to the macula is often missed in clinical practice. Some of the reasons are:

1. traditional glaucoma knowledge supports that glaucoma is fundamentally a peripheral disease;
2. inherent limitations of conventional clinical tests to detect damage to the macula; and
3. the paucity of large, prospective studies that describe the nature of glaucomatous damage to the macula.

The investigators have published numerous papers in the past two years showing that macular damage is prevalent among patients with early glaucoma if one employs the appropriate tools to assess it, namely 10-2 visual fields and high-resolution optical coherence tomography (OCT). This information comes from a unique prospective cross- sectional database and techniques the investigators developed to produce objective metrics of structure and function.

Now that the investigators understand the cross-sectional nature of macular damage, this proposal aims to:

1. develop a longitudinal database including patients with early glaucoma and healthy controls,
2. to test models that explain progression of macular damage, and
3. to apply new statistical methods combining structural and functional tests which could improve the accuracy to detect progression and shorten the length of clinical trials.

The main hypothesis is that incorporating 10-2 visual field testing and high-resolution OCT scans of the macula to the conventional repertoire of technologies used in clinical practice, in addition to translating recently described statistical methods into softwares that can be used in daily practice, enhances the performance and confidence to detect glaucoma progression.

In Aim 1 the investigators plan to follow healthy subjects and glaucoma patients at regular intervals with 10-2, 24-2 visual fields, and swept source (ss) OCT tests and define metrics of short- and long-term test variability that are needed to differentiate true progression from 'noise'. To date, there is no such database combining these technologies.

In Aim 2 the investigators plan to combine metrics of structure and function from this longitudinal database using two methods: a spatial approach, which will ultimately produce a joint structure-function index using 10-2 and ssOCT data; and a temporal approach, which will employ Bayesian statistics to measure rates of progression using trend analysis. By the end of the study, our contributions to the field should be:

1. to make available a unique and pristine longitudinal database that could be used for other hypotheses testing,
2. to translate techniques recently described in the literature into objective tools to be readily useful in clinical practice, and
3. to mitigate the burdens of progressive loss of central vision in glaucoma.

• Study Type: Observational
• Enrollment (Anticipated): 375

Contacts and Locations

• Study Contact: Name: Lam Lu, BS; Phone Number: 646-457-0940; Email: ll3051@cumc.columbia.edu

Study Locations

• United States
  • New York
    • New York, New York, United States, 10032
      • Recruiting
      • CUIMC Harkness Eye Institute
      • Contact: Lam Lu, BS; Phone Number: 646-457-0940; Email: ll3051@cumc.columbia.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 85 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients seen in Columbia eye clinics and enrolled in cross-sectional database; Columbia University Medical Center Eye Institute.

Description

Glaucoma Group:

Inclusion Criteria:

• glaucomatous optic neuropathy (as defined in the American Academy of Ophthalmology Preferred Practice Pattern criteria)

Exclusion Criteria:

• late functional glaucomatous damage
• significant cataract
• previous ocular surgery (aside from uncomplicated cataract extraction with intraocular lens (IOL) implantation and/or trabeculectomy, LASIK or refractive surgeries)
• diabetic retinopathy with macular edema
• vein or artery occlusion
• exudative age-related macular degeneration or geographic atrophy
• macular hole or traction
• amblyopia
• uveitis
• non-open angle glaucoma (e.g. angle closure, traumatic, congenital glaucoma)
• severe myopia or hyperopia (refractive error greater than -6 or +6D, respectively)
• retinal detachment (current or post-surgery)
• retinitis pigmentosa
• significant epiretinal memberane
• significant kerotoconus

Healthy Group:

Inclusion Criteria:

• best corrected visual acuity equal or better than 20/40
• normal biomicroscopy examination
• gonioscopically open angles
• Intraocular Pressure (IOP) lower than 22 mmHg
• normal and reliable 24-2 and 10-2 SAP results

Exclusion Criteria:

• evidence of optic neuropathy
• evidence of clinically significant metabolic diseases (e.g. diabetes and hypotension)

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Early Glaucomatous Damage; Patients with early functional glaucomatous damage.
Ophthalmologically Healthy; Healthy subjects that are ophthalmologically normal

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in 10-2 visual field	Evidence of functional glaucomatous damage on the macula as confirmed by visual fields: A slope of 10-2 visual field change faster than -1 dB/year at P<5%	Baseline and 3 years
Change in macular ganglion cell thickness	Evidence of structural glaucomatous damage on the macula as confirmed by OCT imaging: evidence of macular ganglion cell thickness slope less than -10 microns/year	Baseline and 3 years

Collaborators and Investigators

• Sponsor: Columbia University
• Collaborators: National Eye Institute (NEI)
• Investigators: Principal Investigator: Jeffrey Liebmann, MD, Columbia University

Publications and helpful links

General Publications

• Hood DC, Tsamis E, Bommakanti NK, Joiner DB, Al-Aswad LA, Blumberg DM, Cioffi GA, Liebmann JM, De Moraes CG. Structure-Function Agreement Is Better Than Commonly Thought in Eyes With Early Glaucoma. Invest Ophthalmol Vis Sci. 2019 Oct 1;60(13):4241-4248. doi: 10.1167/iovs.19-27920. Erratum In: Invest Ophthalmol Vis Sci. 2020 Nov 2;61(13):32.

Study record dates

Study Major Dates

• Study Start (ACTUAL): October 1, 2015
• Primary Completion (ANTICIPATED): October 1, 2023
• Study Completion (ANTICIPATED): December 1, 2023

Study Registration Dates

• First Submitted: September 10, 2015
• First Submitted That Met QC Criteria: September 10, 2015
• First Posted (ESTIMATE): September 11, 2015

Study Record Updates

• Last Update Posted (ACTUAL): November 8, 2022
• Last Update Submitted That Met QC Criteria: November 4, 2022
• Last Verified: November 1, 2022

More Information

Terms related to this study

• Keywords: optical coherence tomography; macula; visual fields; glaucoma progression; retinal ganglion cells
• Additional Relevant MeSH Terms: Pathologic Processes; Eye Diseases; Disease Attributes; Ocular Hypertension; Glaucoma; Disease Progression
• Other Study ID Numbers: AAAO8502; 1R01EY025253-01 (NIH)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO