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Arindel Stefon Maharaj, Mitra Sehi, David S Greenfield, Shawn M Iverson, Iman Goharian, Xinbo Zhang, Brian A Francis, Joel S Schuman, Rohit Varma, David Huang, Advanced Imaging for Glaucoma Study Group; PROGRESSIVE RETINAL NERVE FIBER LAYER ATROPHY IS ASSOCIATED WITH THIN CENTRAL CORNEAL THICKNESS IN GLAUCOMA SUSPECT AND GLAUCOMATOUS EYES. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4752.
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To prospectively examine the relationship between central corneal thickness (CCT) and longitudinal changes in retinal nerve fiber layer thickness (RNFL) over time identified using time-domain optical coherence tomography (TDOCT) in glaucoma suspect and preperimetric glaucoma (GSPPG) and perimetric glaucoma (PG) patients.
This was a multicenter prospective longitudinal clinical trial. Eligible eyes with ≥2 years of follow-up underwent TDOCT and standard automated perimetry (SAP) every 6 months. CCT was measured in all eyes at the baseline examination. RNFL progression was defined as a significant negative decline (p<0.05) in slope of average RNFL thickness. SAP progression was defined as a significant (p<0.05) negative visual field index (VFI) slope over time. Cox proportional hazard ratios (HR) were calculated using univariate and multivariate models with RNFL loss as a time-dependent covariate for age, race, gender, CCT, baseline intraocular pressure (IOP), visual field index (VFI), mean deviation (MD), pattern standard deviation (PSD) and HRT linear cup to disc ratio (HRTLCDR).
177 PG eyes and 310 GSPPG eyes were included. The mean age was 60.3±9.5 years. The average number of TDOCT and SAP examinations for each eye was 8.6±2. Eighty-nine eyes had SAP progression and 101 eyes showed significant progressive RNFL loss. Eyes with RNFL progression had thinner CCT (544.9±38.7µm, p<0.001) compared with non-progressive eyes (551.6±35.1µm). Eyes with VFI progression had thinner CCT (546.3±35.7µm, p=0.04) compared with non-progressive eyes (551.1±35.5µm). In multivariate Cox models, eyes with thinner CCT were likely to experience RNFL loss compared with eyes with thicker CCT (HR=1.40 per 50µm thinner CCT, p<0.001).
Glaucoma suspect and glaucomatous eyes with thin CCT are at increased risk for progressive RNFL atrophy over time.
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