September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Progression in Glaucoma Suspects is Detected Earlier with Imaging than Standard Automated Perimetry
Author Affiliations & Notes
  • Alberto Diniz-Filho
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
    Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  • Linda M Zangwill
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Akram Belghith
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Robert N Weinreb
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Felipe A Medeiros
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Footnotes
    Commercial Relationships   Alberto Diniz-Filho, None; Linda Zangwill, Carl Zeiss Meditec Inc. (F), Carl Zeiss Meditec Inc. (R), Heidelberg Engineering GmbH (F), Optovue Inc. (F), Optovue Inc. (R), Quark (F), Topcon Inc. (F); Akram Belghith, None; Robert Weinreb, Alcon Inc. (C), Allergan Inc. (C), Bausch + Lomb (C), Carl Zeiss Meditec Inc. (C), Carl Zeiss Meditec Inc. (F), Carl Zeiss Meditec Inc. (R), Genentech (F), Heidelberg Engineering GmbH (F), Optovue Inc. (F), Topcon Inc. (C), Topcon Inc. (F); Felipe Medeiros, Alcon Inc. (F), Alcon Inc. (R), Allergan Inc. (C), Allergan Inc. (F), Allergan Inc. (R), Bausch + Lomb (F), Carl Zeiss Meditec Inc. (C), Carl Zeiss Meditec Inc. (F), Carl Zeiss Meditec Inc. (R), Heidelberg Engineering GmbH (F), Merck Inc. (F), National Eye Institute (F), Novartis (C), Reichert Inc. (R), Reichert Inc. (F), Sensimed (F), Topcon Inc. (F)
  • Footnotes
    Support  NIH grant EY021818; NIH grant EY011008; NIH core grant P30EY022589; an unrestricted grant from Research to Prevent Blindness; fellowship from Brazilian National Council for Scientific and Technological Development (CNPq) 233829/2014-8.
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 353. doi:
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      Alberto Diniz-Filho, Linda M Zangwill, Akram Belghith, Robert N Weinreb, Felipe A Medeiros; Progression in Glaucoma Suspects is Detected Earlier with Imaging than Standard Automated Perimetry. Invest. Ophthalmol. Vis. Sci. 2016;57(12):353.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To estimate the time to detect progression in glaucoma suspects followed over time with spectral-domain optical coherence tomography (SDOCT) and standard automated perimetry (SAP).

Methods : This was a prospective observational cohort study involving 376 eyes of 250 patients suspected of having glaucoma. All eyes had normal SAP results at baseline and were followed for an average of 4.6 ± 1.1 years with an average of 8.7 ± 3.2 SAP and SDOCT tests. Ordinary least squares linear regression (OLS) models were used to regress SAP mean deviation (MD) and SDOCT (Spectralis, Heidelberg Engineering, Dossenheim, Germany) average retinal nerve fiber layer thickness (RNFL) values over time for each eye. Residuals were extracted from OLS regression to represent the expected variability estimates for levels of SAP MD and RNFL thickness. Distributions of residuals were then obtained for each level of MD or RNFL thickness in the population. These distributions allowed reconstruction of SAP MD and SDOCT average RNFL thickness trajectories over time by computer simulation, according to expected “true” rates of glaucoma progression. 100,000 tests were then simulated for SAP and SDOCT under different assumptions about rate of change and frequency of testing. Empirical cumulative distribution functions (CDF) were built to investigate the probability of detecting progression (i.e., statistically significant slope) over time.

Results : Average SAP MD at baseline was -0.48 ± 1.4 dB, whereas SDOCT average RNFL thickness was 89.3 ± 12.2 μm. Median absolute residuals were 0.51 dB (IQR: 0.23 –0.78) and 1.15 μm (IQR: 0.57 – 2.78) for SAP MD and SDOCT average RNFL thickness, respectively. When simulations were performed assuming true rates of progression of -0.75 μm/year and -0.13 dB/year (average rates of change in the cohort) and 6-month testing interval, the median time to detect progression was significantly earlier with SDOCT than SAP (mean difference=3.55 years; P<0.01, Figure). At 8 years of follow-up, 82% of patients would have been detected as progressing by SDOCT versus 40% on SAP.

Conclusions : When trend-based methods are used to evaluate change in global indices of structure and function, detection of progression is seen significantly earlier with SDOCT than SAP.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

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