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David Huang, Xinbo Zhang, Rohit Varma, David S. Greenfield, Joel S. Schuman, Advanced Imaging for Glaucoma Study Group; Nerve Fiber Layer and Ganglion Cell Complex Measurements by Optical Coherence Tomography as Risk Factors for Visual Field Progression in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2260.
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© ARVO (1962-2015); The Authors (2016-present)
To determine whether optical coherence tomography (OCT) measurements are useful in predicting the worsening of glaucomatous visual field (VF) defects.
We analyzed the data from perimetric glaucoma (PG) patients enrolled in the multi-center longitudinal Advanced Imaging for Glaucoma Study (www.AIGStudy.net). Both time-domain (TD) and Fourier-domain (FD) OCT were used to measure peripapillary retinal nerve fiber layer (NFL) thickness. Macular ganglion cell complex (GCC) thickness maps were measured with FD-OCT. Standard automated perimetry was used to assess VF. Subjects were followed every 6 months. VF glaucoma progression was defined as three consecutive follow-up VF’s that show consistent focal worsening of defects (three completely filled black triangles) by Humphrey Glaucoma Progression Analysis (GPA) software. The Cox proportional hazard model was used to calculate the hazard ratios (HR) for the risk factors; the results were adjusted for correlation between the eyes from the same individual. A multivariate model was fitted for each of the OCT parameters with age and VF pattern standard deviation (PSD).
The analysis included 340 eyes (222 participants) with average age of 61.8, among which 127 (57%) are female and 24 (11%) are African Americans. The average PSD at baseline was 5.6 dB while the average mean deviation (MD) was -4.8 dB. The average follow-up time was 36 months. In the cohort, 35 eyes had VF progression. Independent risk factors for visual field progression included overall NFL thickness measured by TD-OCT (HR = 1.33 per 10 micron thinner, p = 0.01), overall NFL thickness measured by FD-OCT (HR = 1.46, per 10 micron thinner, p = 0.05) and Ganglion cell complex thickness measured by FD-OCT (HR = 1.60 per 10 micron thinner, p < 0.001).
Glaucoma patients with thinner NFL or GCC are more likely to have worsening of visual field defects. NFL and GCC thickness measured by OCT over the follow-up period are predictive of VF progression among perimetric glaucoma patients, even after controlling for age and disease severity (VF PSD) in multivariate analysis. OCT has prognostic value in glaucoma.
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