Longitudinal Evaluation of Structural and Functional Progression in Glaucoma with 10-Year Follow-Up

Abstract

 

Purpose

 

Glaucoma is a slowly progressing disease, but the longitudinal changes appearing in the disease are typically assessed in short-term cohorts that often span for no longer than 3 years. The purpose of this study is to evaluate glaucomatous structural and functional progression in an extended long-term cohort using visual field (VF), optical coherence tomography (OCT), and confocal scanning laser ophthalmoscopy (CSLO), in healthy, glaucoma suspect and glaucomatous eyes.

 

Methods

 

Subjects were followed every 6 months with comprehensive ocular examination, VF (Humphrey Field Analyzer, Zeiss, Dublin, CA), multiple OCT iterations (prototype device; other generations by Zeiss, Dublin, CA) and CSLO (Heidelberg Retina Tomograph, Heidelberg Engineering, Heidelberg, Germany). Calibration models were constructed for retinal nerve fiber layer (RNFL) thickness measurements that were acquired with various iterations of the OCT technology. Rate of progression for VF mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI), OCT RNFL thickness, and CSLO rim area, and cup/disc area ratio (CDR) were analyzed using linear mixed effect model accounting for the baseline age.

 

Results

 

212 eyes (138 glaucomatous, 50 glaucoma suspect and 24 healthy) from 120 subjects, were included in the study. The average follow-up period was 9.7 years (47-218 months). Glaucomatous eyes showed significant progression for all parameters (Table). None of the analyzed parameters was significantly changed in the healthy eyes while glaucoma suspects demonstrated intermediary rate of change.

 

Conclusions

 

Rate of structural and functional changes was quantified for 10 years follow-up period showing steep progression in glaucomatous eyes and minimal change in healthy subjects. This information provides a realistic estimate of the long-term glaucomatous effect.

 

 

Keywords: 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • 758 visual fields • 610 nerve fiber layer