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Igor Bussel, Gadi Wollstein, Richard Bilonick, Yun Ling, Hiroshi Ishikawa, Jessica Nevins, Larry Kagemann, Jay Duker, Cynthia Mattox, Joel Schuman; Longitudinal Analysis of Glaucoma Progression by Structure and Function: 7-year Follow-Up by Visual Field (VF) and Optical Coherence Tomography (OCT). Invest. Ophthalmol. Vis. Sci. 2013;54(15):1898. doi: https://doi.org/.
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To longitudinally evaluate glaucoma progression by structure and function measurements using VF and OCT in a long-term cohort.
Sixty eyes (4 healthy, 34 glaucoma suspect, and 22 glaucoma) from 31 subjects followed for an average of 7.4±2.3 years were enrolled to the study. All subjects had ≥5 reliable VF and good quality OCT scans (OCT1, OCT2, Stratus OCT). VF Mean deviation (MD) and OCT mean retinal nerve fiber layer (RNFL) thickness were recorded. A structural equation measurement error model was used to calibrate measurements from multiple OCT devices. VF progression was defined as a decline ≥2dB in MD from baseline, and OCT mean RNFL thinning ≥20μm. Overall trend of VF and OCT progression was also calculated using a linear mixed-effects model and the upper quartile slopes representing rapid progressors were compared.
Qualified subjects had a median of 12 VF and 27 OCT scans. A total of 41 eyes (68.3%) progressed by MD and RNFL criteria with 46.7%, 10.0%, and 11.7% by OCT only, VF only, and both, respectively. From the 7 eyes that progressed by both, 3 eyes progressed by structure and function simultaneously, 3 progressed by OCT before VF, and 1 progressed by VF before OCT. Using the same progression criteria after 4, 5, 6, and 7 years of follow-up, there was a gradual increase in the number of progressors with all criteria with the agreement between both devices increasing from 6% to 14%. 53% of eyes that were defined as OCT rapid progressors were also labeled as VF rapid progressors.
Though we expected an improved agreement between structure and function in glaucoma progression over the extended follow-up duration, there was only marginal increase in agreement at the tested time points with substantially higher percentage of progression with each modality separately. Therefore, even in an extended follow-up there may be limited detectable correspondence between structural and functional progression.
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