3D integrated approach to structural and functional monitoring in glaucoma.

Aims

To introduce a three-dimensional (3D) trajectory model that integrates structural and functional changes over time to improve assessment and prediction of glaucoma progression.

Methods

This retrospective longitudinal study included 1742 eyes from 996 glaucoma patients with ≥4 years of follow-up. Structural data from various devices were converted into a Structural Metascore (SMS), and the Visual Field Index (VFI) was used as the functional parameter. Robust linear regression was applied to each eye's SMS and VFI over time. Eyes were categorised by baseline mean deviation (MD) into preperimetric (MD ≥0 dB), mild (-6 < MD < 0 dB), moderate (-12 ≤ MD ≤ -6 dB) or severe (MD <-12 dB). Progression was defined as a slope <-1% per year for SMS or VFI.

Results

Mean SMS slopes ranged from -0.1±0.8%/year (preperimetric) to -0.8±0.7%/year (severe) and VFI slopes ranged from -0.2±0.5%/year to -0.9±1.4%/year (p<0.001). Structural and functional slopes were more correlated in earlier stages. Progression classifications were: both structural and functional (6%), structural-only (13%), functional-only (11%) and stable (70%). Functional-only progression was more common in moderate and severe glaucoma, while structural-only progression predominated in earlier stages. The SMS approach achieved 8.9% prediction error compared with 34.1% for single-device methods.

Conclusion

The 3D trajectory model visualises distinct progression patterns, with structural changes preceding functional decline in earlier stages and functional-only progression dominating in advanced stages. This integrated model enhances visualisation and quantification of disease dynamics, supporting personalised glaucoma management.