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Willy Gama, Alon Harris, Brent A Siesky, George Eckert, Rehan Hussain, Darrell WuDunn, Annahita Amireskandari, Leslie Tobe, Alice Chandra Verticchio Vercellin; Baseline optic nerve head morphometric parameters predict functional glaucoma progression in diabetic patients with open-angle glaucoma. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):617.
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© ARVO (1962-2015); The Authors (2016-present)
To examine Optic Nerve Head (ONH) morphology and functional progression in patients with open-angle glaucoma (OAG) with and without Diabetes Mellitus (DM) over a 5-year period.
111 OAG patients (Mean age 65 yr; 20 with DM, 91 without DM) were assessed for optic nerve morphology as measured by Heidelberg retinal tomography (HRT) at baseline and every 6 months for a 5-year period. 77 patients (14 with DM, 63 without DM) were assessed at 5-year follow-up. Functional disease progression was monitored with 24-2 Swedish Interactive Thresholding Algorithm visual field exam using the Humphrey visual field machine and defined as 2 consecutive visits with a mean deviation decrease ≥2 compared to baseline and/or Advanced Glaucoma Intervention Study increase ≥2 compared to baseline. Mixed-model ANCOVA was used to test for significant change from baseline to 5-year follow-up. Time to progression was analyzed using Cox proportional hazards models. Interactions were tested to determine if the effects of the factors on progression time differed by diabetes.
In OAG patients with diabetes, baseline HRT3 parameters were: cup area 0.860 (95% CI: 0.625, 1.130), cup volume 0.286 (0.154, 0.418), cup/disk area ratio 0.404 (0.311, 0.497), linear cup/disk ratio 0.611 (0.529, 0.692), mean cup depth 0.290 (0.232, 0.349), cup shape -0.134 (-0.170, -0.098). In OAG patients without diabetes, baseline HRT3 parameters were: cup area 0.888 (0.772, 1.012), cup volume 0.297 (0.236, 0.359), cup/disk area ratio 0.419 (0.376, 0.463), linear cup/disk ratio 0.629 (0.589, 0.668), mean cup depth 0.302 (0.273, 0.331), cup shape -0.124 (-0.142, -0.105). Higher baseline cup volume and cup depth were associated with time to progression in diabetics only (p<0.05). Higher baseline cup area, cup/disk area ratio, linear cup/disk ratio, and cup shape were associated with short time to progression in all patients.
ONH structural parameters at baseline were predictive of glaucomatous functional progression after 5 years in patients, with significant differences by diabetes status. These data suggest that the ONH structure in patients with diabetes may play a more prominent role in their functional progression.
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