September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Detection of Glaucoma Progression with the RGC Index in High- versus Low-Risk Eyes
Author Affiliations & Notes
  • Courtney Ondeck
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Linda M Zangwill
    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
  • Alberto Diniz-Filho
    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   Courtney Ondeck, 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 Medical Systems Inc. (F); Robert Weinreb, Alcon (C), Allergan (C), Bausch+Lomb (C), Carl Zeiss Meditec (C), Carl Zeiss Meditec (F), Carl Zeiss Meditec Inc. (R), Genentech (F), Heidelberg Engineering (F), Optovue (F), Topcon (C), Topcon (F); Alberto Diniz-Filho, None; Felipe Medeiros, Alcon Laboratories Inc. (R), Alcon Laboratories Inc. (F), Allergan Inc. (F), Allergan Inc. (R), Allergan Inc. (C), Bausch & Lomb (F), Carl Zeiss Meditec Inc. (F), Carl Zeiss Meditec Inc. (R), Carl Zeiss Meditec Inc. (C), Heidelberg Engineering Inc. (F), Merck Inc. (F), National Eye Institute (F), Novartis (C), Reichert Inc. (R), Reichert Inc. (F), Sensimed (F), Topcoat Inc. (F)
  • Footnotes
    Support  NIH grant EY021818; NIH core grant P30EY022589; an unrestricted grant from Research to Prevent Blindness.
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 349. doi:
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    • Get Citation

      Courtney Ondeck, Linda M Zangwill, Robert N Weinreb, Alberto Diniz-Filho, Felipe A Medeiros; Detection of Glaucoma Progression with the RGC Index in High- versus Low-Risk Eyes. Invest. Ophthalmol. Vis. Sci. 2016;57(12):349.

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

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Abstract

Purpose : To investigate rates of progression with an index combining structure and function (RGC index) in glaucoma eyes deemed at high- versus low-risk of progression.

Methods : This was a prospective longitudinal observational study involving 397 eyes of 274 patients followed for an average of 3.8 ± 1.1 years. All eyes had glaucomatous visual field loss at baseline. Subjects had an average of 7.3 ± 3.7 spectral domain optical coherence tomography (SDOCT) and standard automated perimetry (SAP) visual field tests during follow-up. Glaucoma eyes were classified as high- versus low-risk of progression based on intraocular pressure measurements and central corneal thickness during follow-up. Low-risk eyes were required to have maximum IOP below 18 mmHg at all visits during follow-up with mean IOP below 15 mmHg. CCT in these eyes had also to be greater than 520 μm. High-risk eyes had maximum IOP higher than 22 mmHg during follow-up, with mean IOP higher than 15 mmHg. CCT in high-risk eyes had to be lower than 580 μm. Estimated retinal ganglion cell counts (RGC index) were obtained from SDOCT and SAP data using a previously described method (Medeiros et al. Am J Ophthalmol. 2012; 154:814-824). Linear mixed effects models were used to compare rates of progression in high- versus low-risk eyes using the RGC index as well as average retinal nerve fiber layer (RNFL) thickness and SAP mean deviation (MD).

Results : 78 eyes were classified as high-risk and 101 eyes as low-risk. Average mean IOP was 19.8 ± 3.3 vs. 11.1 ± 3.1mmHg, respectively (P<0.001). Average maximum IOP was 26.8 ± 4.7 vs. 14.2 ± 2.9 mmHg, respectively (P<0.001). Mean age was not significantly different between the groups (66.3 vs. 67.7 years; P=0.422). Rates of change in the RGC index were over 3 times faster in the high-risk versus low-risk group (-15,719 vs. -4,507 cells/year; P=0.001). Corresponding rates for average RNFL thickness were -0.79 ± 0.72 vs. -0.37 ± 0.48 μm/year, respectively (P=0.047) and, for SAP MD, -0.20 ± 0.42 vs. 0.01 ± 0.32 dB/year (P=0.043).

Conclusions : Eyes at high risk for progression showed significantly faster slopes of change on estimated RGC counts as obtained with the RGC index compared to low-risk eyes.

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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