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Linda M Zangwill, Felipe A Medeiros, Christopher Bowd, Christopher A Girkin, Jeffrey M Liebmann, Robert N Weinreb, Akram Belghith; Detecting Structural Change in Advanced Glaucoma Eyes. Invest. Ophthalmol. Vis. Sci. 2016;57(12):838.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the longitudinal loss of minimum rim width (MRW), circumpapillary retinal fiber layer thickness (cpRNFL) and retinal ganglion cell – inner plexiform layer (GCIPL) measured by spectral domain optical coherence tomography (SD-OCT) in advanced glaucoma eyes and to compare the number of progressing glaucoma eyes using these measurements and a new three dimensional 3D optic nerve head (ONH) change detection method that does not require retinal layer segmentation.
A total of 35 eyes of 35 patients with advanced glaucoma (visual field (VF) mean deviation (MD) worse than -20 dB) from the African Descent and Glaucoma Evaluation Study (ADAGES) and the Diagnostic Innovations in Glaucoma Study (DIGS) were included. 46 eyes of 30 healthy subjects were used to estimate aging changes/specificity. All eyes underwent Spectralis SD-OCT imaging with the cpRNFL, MRW and GCIPL layer thicknesses measured using the San Diego automated layer segmentation algorithm (SALSA). Progression was defined when structural loss was significantly different from zero and faster than the 5st percentile of the healthy group. Progression rates were calculated using mixed effects models. The 3D glaucoma change detection was estimated using the Bayesian-kernel detection scheme (BKDS) (Belghith et al. Artif Intell Med. 2015).
Mean age, visual field MD, years of follow-up and number of visits was 59 years (range 48-72), 0.2 dB, 2.8 years and 6 visits for healthy subjects and 77 years (range 69-92), -28 dB (range -33, -21 dB), 3.5 years and 5 visits for glaucoma subjects. In healthy eyes, mean rates (p-value) of RNFL, MRW and GCIPL change were -0.32 µm/yr (P<0.001), -1.41 µm/yr (P<0.001), and -0.11 µm/yr (P<0.001) respectively; In advanced glaucoma eyes, the rates of change were -0.08 µm/yr (P=0.39), -0.29 µm/yr (P=0.43), and -0.18 µm/yr (P=0.02) respectively. The number of progressing glaucoma eyes identified by cpRNFL, MRW, GCIPL and 13 and BKDS was 2, 4, 11, and 13, respectively. Among the 13 eyes detected by the BKDS, 7 eyes were also identified by GCIPL, 3 eyes by MRW and 1 by cpRNFL.
In these very advanced glaucoma eyes, in contrast to MRW and cpRNFL, mean GCIPL thickness showed a rate of change significantly different than zero. GCIPL and 3D BKDS method shows promise for identifying change in advanced glaucoma. These results suggest that even in very advanced disease, structural change can be detected using SDOCT imaging.
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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