Can Macula and Optic Nerve Head Parameters Detect Glaucoma Progression in Eyes with Advanced Circumpapillary Retinal Nerve Fiber Layer Damage?

Abstract

Purpose: To evaluate the ability of OCT optic nerve head (ONH) and macular parameters to detect disease progression in eyes with advanced structural glaucomatous damage of the circumpapillary retinal nerve fiber layer (cRNFL).

Design: Longitudinal study.

Participants: Forty-four eyes from 37 patients with advanced average cRNFL damage (≤60 μm) followed up for an average of 4.0 years.

Methods: All patients were examined with spectral-domain OCT and visual field (VF) assessment during at least 4 visits.

Main outcome measurements: Visual field mean deviation (MD) and VF index. OCT cRNFL (average, superior, and inferior quadrants), ganglion cell-inner plexiform layer (GCIPL) (average, superior, and inferior), rim area, cup volume, average cup-to-disc (C:D) ratio, and vertical C:D ratio.

Results: At baseline, patients had a median VF MD of -10.18 dB and mean cRNFL of 54.55±3.42 μm. The rate of change for MD and VF index were significant. No significant rate of change was noted for cRNFL, whereas significant (P < 0.001) rates were detected for GCIPL (-0.57±0.05 μm/year) and ONH parameters such as rim area (-0.010±0.001 mm2/year).

Conclusions: Macula GCIPL and ONH parameters may be useful in tracking progression in patients with advanced glaucoma.

Conflict of interest statement

Conflict of Interest: Dr. Schuman receives royalties for intellectual property licensed by Massachusetts Institute of Technology and Massachusetts Eye and Ear Infirmary to Zeiss.

Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Demonstrative subject with advanced glaucoma showing a significant rate of progression for VFI (A); Guided progression analysis (GPA) showing no progression with cRNFL but C/D ratio progression in the last two visits and "possible loss" in the RNFL thickness map progression (B); Significant thinning of the macular GCIPL (C).

Figure 1

Demonstrative subject with advanced glaucoma showing a significant rate of progression for VFI (A); Guided progression analysis (GPA) showing no progression with cRNFL but C/D ratio progression in the last two visits and "possible loss" in the RNFL thickness map progression (B); Significant thinning of the macular GCIPL (C).

Figure 1

Demonstrative subject with advanced glaucoma showing a significant rate of progression for VFI (A); Guided progression analysis (GPA) showing no progression with cRNFL but C/D ratio progression in the last two visits and "possible loss" in the RNFL thickness map progression (B); Significant thinning of the macular GCIPL (C).