June 2013
Volume 54, Issue 15
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ARVO Annual Meeting Abstract  |   June 2013
The Combined Structure and Function Index as a Predictor of Glaucoma Development
Daniel Meira-Freitas; Renato Lisboa; Andrew Tatham; Linda Zangwill; Robert Weinreb; Christopher Girkin; Jeffrey Liebmann; Tammy Kuang; Christopher Bowd; Felipe Medeiros
Author Affiliations & Notes
  • Daniel Meira-Freitas
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, CA
    Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
  • Renato Lisboa
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, CA
    Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
  • Andrew Tatham
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, CA
  • Linda Zangwill
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, CA
  • Robert Weinreb
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, CA
  • Christopher Girkin
    Department of Ophthalmology, University of Alabama, Birmingham, AL
  • Jeffrey Liebmann
    Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY
  • Tammy Kuang
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, CA
    Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
  • Christopher Bowd
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, CA
  • Felipe Medeiros
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, CA
  • Footnotes
    Commercial Relationships Daniel Meira-Freitas, None; Renato Lisboa, None; Andrew Tatham, None; Linda Zangwill, Carl Zeiss Meditec Inc (F), Heidelberg Engineering GmbH (F), Optovue Inc (F), Topcon Medical Systems Inc (F), Nidek Inc (F); Robert Weinreb, Aerie (F), Alcon (C), Allergan (C), Altheos (C), Amakem (C), Bausch&Lomb (C), Carl Zeiss-Meditec (C), Genentech (F), Haag-Streit (F), Heidelberg Engineering (F), Konan (F), Lumenis (F), National Eye Institute (F), Nidek (F), Optovue (C), Quark (C), Solx (C), Topcon (C); Christopher Girkin, SOLX (F), Heidelberg Engineering (F); Jeffrey Liebmann, Alcon Laboratories, Inc. (C), Allergan, Inc. (C), Allergan, Inc. (F), Carl Zeiss Meditech, Inc (F), Heidelberg Engineering, GmbH (F), Topcon Medical Systems, Inc. (F), National Eye Institute (F), New York Glaucoma Research Institute (F), SOLX, Inc. (C), Bausch & Lomb, Inc (C), Diopsys, Inc. (C), Diopsys, Inc. (F), Merz, Inc. (C), Glaukos, Inc. (C), Quark, Inc. (C); Tammy Kuang, None; Christopher Bowd, None; Felipe Medeiros, Carl-Zeiss (F), Heidelberg Engineering (F), Topcon (F), Alcon (F), Allergan (F), Sensimed (F), Reichert (F)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 1887. doi:
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      Daniel Meira-Freitas, Renato Lisboa, Andrew Tatham, Linda Zangwill, Robert Weinreb, Christopher Girkin, Jeffrey Liebmann, Tammy Kuang, Christopher Bowd, Felipe Medeiros; The Combined Structure and Function Index as a Predictor of Glaucoma Development. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1887.

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Abstract
 
Purpose
 

To assess whether baseline combined structure and function index (CSFI) results are predictive of conversion to glaucoma in patients suspected of having the disease.

 
Methods
 

The study included 345 glaucoma suspect eyes at baseline followed for an average of 74.8 months in the Diagnostic Innovations in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES). All eyes had normal standard automated perimetry (SAP) at baseline. Retinal nerve fiber layer (RNFL) thickness assessment was performed with time domain optical coherence tomography (OCT). Conversion was defined as development of repeatable abnormal SAP or progressive optic disc changes during follow-up. Estimates of the number of retinal ganglion cells were obtained by combining data from SAP and OCT according to a previously described method. The CSFI was calculated as the age-corrected percent loss of retinal ganglion cells. The association between baseline predictive factors and conversion to glaucoma was investigated with Cox proportional hazards models. Multivariable models were adjusted for age, intraocular pressure and central corneal thickness. The c-index and the modified R2 index were used to evaluate and compare predictive abilities of different models.

 
Results
 

Fifty-eight (16.8%) eyes converted to glaucoma. Mean baseline CSFI was 14.1% and 0.2% in the converters and nonconverters, respectively. Table 1 shows hazard ratios with 95% confidence interval (CI) for each putative predictive factor for development of conversion. In the multivariable model, higher CSFI was predictive of conversion (adjusted hazard ratio=2.08 per 10% higher; 95%CI: 1.70-2.56; P<0.001). Model including CSFI had superior predictive ability (c-index=0.770; R2=55%) compared to models including standard visual field parameters and OCT average RNFL thickness (c-index from 0.648-0.718; R2 from 15-39% - table 2).

 
Conclusions
 

Baseline CSFI values were predictive of conversion to glaucoma and performed significantly better than conventional approaches for risk stratification of glaucoma suspects.

 
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Keywords: 531 ganglion cells • 464 clinical (human) or epidemiologic studies: risk factor assessment • 627 optic disc  
© 2013, The Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Permission to republish any abstract or part of an abstract in any form must be obtained in writing from the ARVO Office prior to publication.
Copyright © 2025 Association for Research in Vision and Ophthalmology.
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