Confocal Laser Scanning Tomography to predict Visual Field Conversion in Glaucoma Suspects and Patients with Ocular Hypertension

Abstract

Purpose: To compare Moorfields Regression Analysis (MRA), Glaucoma Probability Score (GPS) and different multivariate analyses to predict future visual field conversion of glaucoma suspects and ocular hypertensive subjects.

Methods: The study included 120 eyes of patients with ocular hypertension and 110 eyes of patients with suspected glaucoma from the Erlangen glaucoma registry (ClinicalTrials.gov number, NTC00494923). Annually, all patients underwent standard automated perimetry, 24-hour intraocular pressure profile, optic disc photography and HRT (Heidelberg Retina Tomograph I-III; Heidelberg Engineering) measurements. The cohort was divided into two groups based on the development of repeatable glaucomatous visual fields. Positive (PPV) and negative predictive values (NPV) were compared for MRA, GPS and the published multivariate analyses at baseline. Kaplan-Meier survival curves and Logrank tests were used to evaluate equality of survival distributions for different test results.

Results: Median follow-up was 9.04 years. 26 eyes (11.3 %) demonstrated glaucomatous visual field loss in the follow-up. MRA temporal-superior and temporal-inferior sector outside normal limits were predictive of future visual field loss with PPVs of 33.3% and 28.6%. GPS temporal sector within normal limits demonstrated a NPV of 96.4% and published multivariate analyses within normal limits demonstrated a NPV between 94.7% and 95.5%.

Conclusions: Confocal scanning laser tomography is an useful imaging modality to predict future visual field conversion. Development of visual field defects in 10 years is highly unlikely, if GPS classification and/ or classification of discriminant analysis at baseline are normal. MRA temporal-superior and temporal-inferior outside normal limits are associated with future VF conversion.

Keywords: 550 imaging/image analysis: clinical • 627 optic disc • 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)