Format

Send to

Choose Destination
Graefes Arch Clin Exp Ophthalmol. 2018 Jul;256(7):1227-1234. doi: 10.1007/s00417-018-3963-3. Epub 2018 Apr 5.

Event-based analysis of visual field change can miss fast glaucoma progression detected by a combined structure and function index.

Author information

1
Visual Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University School of Medicine, 2310 Erwin Rd, Durham, NC, 27710, USA.
2
Department of Ophthalmology, the First Affiliated Hospital, Harbin Medical University, Harbin, China.
3
Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, UK.
4
Visual Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University School of Medicine, 2310 Erwin Rd, Durham, NC, 27710, USA. felipe.medeiros@duke.edu.

Abstract

PURPOSE:

To investigate the relationship between progression assessed by the visual field guided progression analysis (GPA) and rates of structural and functional change in glaucoma eyes.

METHODS:

This was a longitudinal observational study of 135 eyes of 97 patients with glaucoma followed for an average of 3.5 ± 0.9 years. All patients had standard automated perimetry (SAP) and retinal nerve fiber layer (RNFL) analysis with spectral domain optical coherence tomography (SDOCT), with an average of 6.8 ± 2.3 visits. A control group of healthy eyes followed longitudinally was used to estimate age-related change. Visual field progression was assessed using the Humphrey Field Analyzer GPA. Estimates of retinal ganglion cell counts from SAP and SDOCT were used to obtain a combined index of glaucomatous damage (RGC index) according to a previously described algorithm. Progression by SDOCT and the retinal ganglion cell (RGC) index were defined as statistically significant (P < 0.05) slopes of change that were also faster than age-related change estimated from healthy eyes.

RESULTS:

From the 135 eyes, 15 (11%) progressed by GPA, 21 (16%) progressed by SDOCT, and 31 (23%) progressed by the RGC index. Twenty-one eyes showed progression by the RGC index that was missed by the GPA. These eyes had an average rate of change in estimated RGC counts of - 28,910 cells/year, ranging from two to nine times faster than expected age-related losses.

CONCLUSION:

Many glaucomatous eyes that are not found to be progressing by GPA may actually have fast rates of change as detected by a combined index of structure and function.

KEYWORDS:

Combined structure function index; Glaucoma progression; Optical coherence tomography; Visual field

PMID:
29623461
DOI:
10.1007/s00417-018-3963-3
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center