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Nariman Nassiri, Naveed Nilforushan, Elena Bitrian, Dennis Mock, Anne L. Coleman, Simon K. Law, Joseph Caprioli, Kouros Nouri-Mahdavi; Functional and Structural Rates of Glaucoma Progression Are Poorly Correlated. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4137.
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© ARVO (1962-2015); The Authors (2016-present)
To explore correlation of structural and functional rates of glaucoma progression over time with confocal laser ophthalmoscopy (HRT) and standard achromatic visual fields.
One hundred seventeen eyes (76 patients) with definite or suspected glaucoma with >5 good-quality HRT images (pixel SD less than 50 microns) and >5 reliable achromatic visual fields during at least 3 years of follow-up were selected from the UCLA’s Glaucoma Division clinical database. The date of the first and last visual fields and HRT images were required to be within 6 months of each other. HRT’s global/sectoral rim area and visual field mean deviation (MD) and the average loss in visual field clusters (based on Garway-Heath structure-function maps) were regressed against follow-up time to estimate rates of progression. The correlation between structural and functional rates of progression in eyes showing a negative trend for global or sectoral rim area over time (p <0.15) was explored with bivariate correlation analysis.
The mean (± SD) follow-up time was 9.3 ± 3.0 years and the median baseline MD was -3.5 (range: 2.9 to -30.3). The median (range) number of HRT images and visual field exams were 6 (5-10) and 12 (6-34), respectively. The superotemporal (median rate: -0.0013 mm2/year) and inferotemporal sectors (median rate: -0.001 mm2/year) were the sectors with fastest progression rates. A significant correlation between rates of progression was found between HRT’s superotemporal sector and inferior peripheral (Spearman’s r =0.45; p =0.004) and midperipheral visual field clusters (r =0.48; p =0.002) and between HRT’s superonasal sector and inferior peripheral (r =0.60; p <0.001) and midperipheral visual field clusters (r =0.45; p =0.008). The results did not change significantly when only eyes with MD <-8 dB were reanlayzed.
The correlation between structural and functional rates of progression was not uniform across disc sectors and visual field regions and was moderate at best. Functional and structural tests should both be used for estimating rates of progression in glaucoma.
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