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Naama Hammel, Linda Zangwill, Atsuya Miki, Sonia Jain, Feng He, Naira Khachatryan, Jeffrey Liebmann, Christopher Girkin, Felipe Medeiros, Robert Weinreb; Detecting Glaucomatous Structural Changes in Glaucoma Suspect Eyes Using a Cohort of Stable Glaucoma Patients. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4802.
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To establish normative test-retest variability limits for Spectralis SD-OCT retinal nerve fiber layer thickness (RNFLT) measurements using a cohort of stable glaucoma patients, and to evaluate whether changes exceeding these limits are associated with the development of glaucomatous visual field damage in a group of glaucoma suspects.
In order to estimate the 95 and 99 percentile variability limits, a group of stable glaucoma patients with repeatable visual field damage underwent weekly Spectralis SD-OCT testing over a period of approximately 5 weeks. Fifty-five eyes of 29 stable glaucoma patients were included to compute the “95%change” and “99%change” (progression, improvement or both) criteria. Glaucoma suspects, defined as subjects having glaucomatous optic neuropathy based on stereo-photograph review or ocular hypertension without repeatable visual field damage at baseline, and ≥3 Spectralis SD-OCT visits were included. Eyes were classified as converts or non-converts based on the development of repeatable (3x) visual field damage. Glaucoma Suspect eyes were classified as having a repeatable RNFLT change if ≥2 visits change exceeded the 95% and/or 99% change cut-offs; otherwise eyes were considered as not changing.
474 eyes of 312 glaucoma suspects included had a median of 4 SD-OCT visits (range 3 to 11) over a median of 2.3 years. Seventy-nine eyes (16.6%) were classified as converts and 395 eyes (83.4%) were classified as non-converts. Of the 90 patients who met 99% progression criteria for global RNFLT 22 (27.85%) were converts and 68 (75.56%) non-converts. Of the 21 patients who met the 99% progression criteria for RNFLT Superior 4 (19%) were converts and 17 (81%) non-converts. Of the 81 patients who met the 99% progression criteria for RNFLT Inferior 15 (18.52%) were converts and 66 (81.48%) non-converts. Significant associations were observed between visual field conversion and global RNFL thinning exceeding the 95% and 99% cut-offs (odds ratios= 1.69 (95% CI 1.006, 2.84) and 1.84 (95% CI 1.05, 3.22) respectively). There were no significant associations between VF conversion and sectoral RNFL thinning.
The development of visual field damage was associated with global RNFL thinning established using limits derived from SD-OCT testing of stable glaucoma eyes.
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