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L. M. Alencar, R. N. Weinreb, G. Vizzeri, L. M. Zangwill, C. Bowd, P. A. Sample, F. A. Medeiros; Comparison of Rates of Change in Rim Area and Retinal Nerve Fiber Layer Thickness Measurements in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2252.
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To evaluate and compare rates of change in neuroretinal rim area and retinal nerve fiber layer (RNFL) thickness measurements in glaucomatous patients and individuals suspected of having the disease followed over time.
This was an observational cohort study that included 199 eyes of 136 patients recruited from the longitudinal Diagnostic Innovations in Glaucoma Study - DIGS, which were followed with standard achromatic perimetry (SAP), optic disc stereophotographs, confocal scanning laser ophthalmoscopy (HRT 3) and scanning laser polarimetry (GDx VCC) imaging. Progression was determined by the Guided Progression Analysis (GPA) software for visual fields and by masked assessment of optic disc stereophotographs performed by expert graders. Random coefficient models were used to evaluate rates of change in RNFL thickness and rim area measurements and their relationship with progression detected by optic disc stereophotographs and SAP.
From the 199 eyes, 27 (14%) showed progression by visual fields and/or sterephotographs, during an average (SD) follow-up time of 3.5 (0.6) years. The average rate of decline for RNFL thickness measurements was significantly higher in the progressing group compared to the non-progressing group (-0.53 µm/year vs. -0.21 µm/year, respectively; P = 0.043), whereas the rate of decline for global rim area was not significantly different between these two groups (-0.003 mm2/year vs. -0.002 mm2/year, respectively; P = 0.366). The area under the receiver operating characteristic curve (ROC) to discriminate progressors versus non-progressors was 0.690 for the rate of change in average RNFL thickness and 0.414 for the rate of change in global rim area (P = 0.004).
The ability to discriminate eyes progressing by visual fields and/or stereophotographs from eyes that remained stable by these methods was significantly greater for RNFL thickness measurements compared to rim area.
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