5-year disease progression of patients across the glaucoma spectrum assessed by structural and functional tools.
Seth Natasha Gautam, Kaushik Sushmita, Kaur Savleen, Raj Srishti, Pandav Surinder Singh
AI Summary
This study found structural OCT changes are better for detecting glaucoma progression in suspects, while functional visual field changes are more useful in established glaucoma.
Abstract
Background
Assessment of spectral-domain optical coherence tomography (SD-OCT) compared with visual fields, to detect progression across the glaucoma spectrum.
Methods
In this study, adult glaucoma suspects and patients, with baseline retinal nerve fibre layer (RNFL) thickness on SD-OCT and reliable visual field (VF) tests on Humphrey Field Analyser (HFA) prior to March 2010, were recruited. Functional and structural progression over at least 5 years was compared using Glaucoma Progression Analysis (GPA) and VF index (VFI) on HFA and Guided Progression Analysis (GPA-OCT) on SD-OCT, respectively. Agreement of progression detection between the two modalities was computed using κ statistics.
Results
122 subjects (63 glaucoma suspects; 59 glaucoma patients) were enrolled. Of 18 suspects who progressed to glaucoma, 13 showed progression by GPA-OCT, 4 by GPA, 7 by VFI and 2 were concordant. In the 14 glaucoma patients who progressed, GPA-OCT detected progression in 6, GPA in five and VFI in six. GPA-OCT had poor agreement with GPA in glaucoma suspects (Kappa 0.15; p=0.13) and patients (Kappa 0.10; p=0.45). VFI had better agreement with GPA-OCT in glaucoma suspects (Kappa 0.34; p=0.01) than glaucoma patients (Kappa 0.12; p=0.36). Progressors by VF in both groups had similar percentage change from baseline RNFL thickness (-9.9% vs -8.6% p=0.46), even though the absolute change was significantly greater in suspects(-8.75µ vs-6.4µ p=0.03).
Conclusion
Structural change appears to be more useful to detect progression in glaucoma suspects, while functional change is a better indicator as the disease progresses. Percentage change from baseline RNFL thickness was a better measure than absolute change in RNFL.
MeSH Terms
Shields Classification
Key Concepts6
In a 5-year prospective cohort study of 122 subjects (63 glaucoma suspects; 59 glaucoma patients), 18 glaucoma suspects progressed to glaucoma, with 13 detected by Guided Progression Analysis (GPA-OCT), 4 by Glaucoma Progression Analysis (GPA), 7 by Visual Field Index (VFI), and 2 showing concordance between modalities.
In a 5-year prospective cohort study of 122 subjects (63 glaucoma suspects; 59 glaucoma patients), Guided Progression Analysis (GPA-OCT) showed poor agreement with Glaucoma Progression Analysis (GPA) in glaucoma suspects (Kappa 0.15; p=0.13) and glaucoma patients (Kappa 0.10; p=0.45).
In a 5-year prospective cohort study of 122 subjects (63 glaucoma suspects; 59 glaucoma patients), Visual Field Index (VFI) had better agreement with Guided Progression Analysis (GPA-OCT) in glaucoma suspects (Kappa 0.34; p=0.01) than in glaucoma patients (Kappa 0.12; p=0.36).
In a 5-year prospective cohort study of 122 subjects (63 glaucoma suspects; 59 glaucoma patients), progressors detected by visual field in both groups had similar percentage change from baseline retinal nerve fibre layer (RNFL) thickness (-9.9% vs -8.6% p=0.46), even though the absolute change was significantly greater in suspects (-8.75µ vs -6.4µ p=0.03).
In a 5-year prospective cohort study of 122 subjects (63 glaucoma suspects; 59 glaucoma patients), structural change assessed by spectral-domain optical coherence tomography (SD-OCT) appears to be more useful to detect progression in glaucoma suspects, while functional change assessed by visual fields is a better indicator as the disease progresses.
In a 5-year prospective cohort study of 122 subjects (63 glaucoma suspects; 59 glaucoma patients), percentage change from baseline retinal nerve fibre layer (RNFL) thickness was a better measure than absolute change in RNFL for detecting disease progression.
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