September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Investigating the relationship between changes in retinal nerve fiber layer (RNFL) thickness and visual field (VF) damage in glaucoma patients with existing visual field loss
Author Affiliations & Notes
  • Luke J Saunders
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California San Diego, San Diego, California, United States
  • Alexa Li
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California San Diego, San Diego, California, United States
  • Akram Belghith
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California San Diego, San Diego, California, United States
  • Felipe A Medeiros
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California San Diego, San Diego, California, United States
  • Jeffrey L Goldberg
    Byers Eye Institute, Stanford University, Palo Alto, California, United States
  • Jeffrey M Liebmann
    Harkness Eye Institute, Columbia University Medical Center, New York, New York, United States
  • Christopher A Girkin
    School of Medicine, University of Alabama, Birmingham, Alabama, United States
  • Christopher Bowd
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California San Diego, San Diego, California, United States
  • Robert N Weinreb
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California San Diego, San Diego, California, United States
  • Linda M Zangwill
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California San Diego, San Diego, California, United States
  • Footnotes
    Commercial Relationships   Luke Saunders, None; Alexa Li, None; Akram Belghith, None; Felipe Medeiros, Alcon Laboratories, Inc. (R), Alcon Laboratories, Inc. (C), Allergan, Inc. (F), Allergan, Inc. (C), Allergan, Inc. (R), 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), Topcon, Inc. (F); Jeffrey Goldberg, None; Jeffrey Liebmann, Allergan, Inc. (C), Allergan, Inc. (F), Bausch & Lomb, Inc. (F), Bausch & Lomb, Inc. (C), Carl Zeiss Meditech, Inc. (F), Diopysis, Inc. (C), Diopysis, Inc. (F), Heidelberg Engineering, GmbH (C), Heidelberg Engineering, GmbH (F), Merz Pharmaceuticals, Inc. (C), Optovue, Inc. (F), Quark Pharmaceuticals, Inc. (F), Reichert, Inc. (F), Sensimed, Inc. (F), Topcon, Inc. (F), Valeant Pharmaceuticals, Inc. (C); Christopher Girkin, Carl Zeiss Meditec, Inc. (F), EyeSight Foundation of Alabama (F), Heidelberg Engineering, GmbH (F), National Eye Institute (F), Research to Prevent Blindness (F), SOLX (F); Christopher Bowd, None; Robert Weinreb, Aerie (F), Alcon (C), Allergan (C), Amatek (C), Aquesys (C), Bausch & Lomb (C), Carl Zeiss Meditec (F), Carl Zeiss Meditec (C), Genentech (F), Heidelberg Engineering GmbH (F), Nidek (F), Novartis (F), Optovue (F), Topcon (F), Topcon (C), Valeant (C); Linda Zangwill, Carl Zeiss Meditec, Inc. (F), Carl Zeiss Meditec, Inc. (P), Heidelberg Engineering GmbH (F), Nidek, Inc. (F), Optovue, Inc. (F), Quark (F), Topcon Medical Systems, Inc. (F)
  • Footnotes
    Support  NH Grants: EY022589, EY19869, EY11008 and EY021818
Investigative Ophthalmology & Visual Science September 2016, Vol.57, No Pagination Specified. doi:
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    • Get Citation

      Luke J Saunders, Alexa Li, Akram Belghith, Felipe A Medeiros, Jeffrey L Goldberg, Jeffrey M Liebmann, Christopher A Girkin, Christopher Bowd, Robert N Weinreb, Linda M Zangwill; Investigating the relationship between changes in retinal nerve fiber layer (RNFL) thickness and visual field (VF) damage in glaucoma patients with existing visual field loss. Invest. Ophthalmol. Vis. Sci. 201657(12):.

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

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Abstract

Purpose : Few studies have examined how structural change and further progression are related in glaucomatous eyes with existing VF damage. This longitudinal study examined whether rates of RNFL thinning are associated with different methods of assessing visual field progression.

Methods : 452 eyes of 240 patients with existing repeatable VF loss enrolled in the African Descent and Glaucoma Evaluation Study (ADAGES) and the Diagnostic Innovations in Glaucoma Study (DIGS) were included. Each eye had a minimum of 3 RNFL measurements using Spectral Domain Optical Coherence Tomography and 5 Humphrey SITA Standard VFs. Mixed models were fitted to determine the relationship between RNFL thickness and whether a patient progressed to one of three VF endpoints: “Likely Progression” in Guided Progression Analysis (GPA) and significant regression of the Mean Deviation (MD) or the Visual Field Index (VFI). Mean intraocular pressure, central corneal thickness, age and pattern standard deviation were used as covariates.

Results : With a median follow-up of 4.43 years (IQR range: 3.8-4.9), progression was classified in more eyes using trend analyses than event analysis (137 (30%) for MD regression, 149 (33%) for VFI regression and 49 (11%) for GPA). RNFL thickness significantly thinned over time in all RNFL quadrants (p<0.001); the mean (95% CI) rate of RNFL thinning ranged from -0.36 μm/yr (-0.57 to -0.16) in the nasal quadrant to -1.04 μm/yr (-1.24 to -0.85) in the inferior quadrant. Compared to eyes that did not reach a VF endpoint, rates of RNFL thinning were significantly faster in the inferior quadrant of eyes that progressed in GPA (-1.47 μm/yr against -0.78 μm/yr; p=0.041) and in the temporal quadrant of eyes with significant VFI loss (-0.99 μm/yr against -0.39 μm/yr; p=0.002). Rates of RNFL thinning were not significantly faster in eyes that reached VF endpoints compared to those that did not in any other sectors.

Conclusions : In eyes with existing VF loss, there is evidence rates of RNFL thinning are faster in the inferior and temporal quadrants in eyes demonstrating GPA and VFI progression respectively compared to eyes not reaching these endpoints.

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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