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Dimitrios Kourkoutas, Yvonne M. Buys, John G. Flanagan, Nicolaos Karamaounas, Gerasimos Georgopoulos, Evaggelos Iliakis, Michael Moschos, Graham E. Trope; Clinical Significance of Optic Disc Progression by Topographic Change Analysis Maps in Glaucoma and Ocular Hypertension: An 8-year Follow-up Study. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4135.
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To prospectively determine how well the Heidelberg Retina Tomograph (HRT) Topographic Change Analysis (TCA) maps are able to predict the development of optic nerve head (ONH) and/or visual field (VF) change, in clinically stable (at enrolment) patients with OHT and glaucoma.
Following a retrospective study, 78 clinically stable eyes (stable on ONH stereophotographs and VFs) of 78 patients were enrolled in a prospective study. Study eyes were classified as TCA-progressed or TCA-stable based on the TCA results. All patients underwent testing with HRT3, VF and ONH stereophotographs at yearly intervals. Progression was determined by masked assessment of optic disc photographs and by glaucoma progression analysis (GPA) on the VF.
The median (IQR) total HRT follow-up time was 8.0 (7.2-9.0) years, which included a median retrospective and prospective follow-up of 4.2 (1.3-8.7) and 3.9 (3.5-4.6) years respectively. VF and/or photographic change occurred in 5 of 17 TCA-stable patients and in 11 of 61 TCA-progressed patients. 10 patients had photographic changes only, 3 patients had VF changes only and 3 patients had photographic and VF changes. Using the Kaplan-Meier method, the mean time for VF and/or ONH progression from recruitment was shorter in TCA-progressed patients (4.9 years, 95% CI: 4.54-5.23 years) than in TCA-stable patients (5.3 years, 95% CI: 4.35-6.26 years). This result did not reach statistical significance (log rank=0.925). The TCA map had a positive predictive value (PPV) of 18.03% and a negative predictive value (NPV) of 70.58%.
In this cohort, by using our study criteria, TCA progression was documented in 61 of 78 subjects but confirmed clinically in only 16 subjects. It is possible that TCA ONH change is associated with earlier clinical glaucoma progression, but it appears that HRT TCA is overly sensitive with poor specificity.
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