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K. Kishor, D. S. Grewal, M. Sehi, C. D. Quinn, D. S. Greenfield, Advanced Imaging in Glaucoma Study Group; Detecting Glaucomatous Progression Using Structural and Functional Measures. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2241.
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© ARVO (1962-2015); The Authors (2016-present)
To compare methods for evaluation of glaucomatous structural and functional progression
Glaucoma suspects and glaucoma patients with 24 months follow-up meeting eligibility criteria were prospectively enrolled. One eye per-subject was randomly selected. All subjects underwent complete eye exam, standard automated perimetry (SAP), scanning laser polarimetry with variable corneal compensation (GDxVCC), and Heidelberg Retina Tomography (HRT). Structural progression was assessed using GDx Guided Progression Analysis (GPA) and HRT Topographic Change Analysis (TCA), and compared with masked evaluation of stereoscopic disc photographs by two glaucoma specialists. Functional progression was assessed using SAP GPA, and linear regression analysis using SAP visual field index (VFI) and ProgressorTM software. Progression methodologies were compared using Chi-square; agreement was evaluated using logistic regression and kappa analyses.
Thirty-one glaucoma suspects (age 62.0±11.6) and 29 glaucoma patients (age 71.0±8.4; p=0.01) were prospectively enrolled. Structural progression was identified in 5/60 (8%) using GDxVCC, 12/60 (20%) using HRT, and 2/60 (3.3%) using optic disc photography (p>0.05). Functional progression was identified in 0/60 using SAP GPA, 5/60 (8%) using SAP VFI, and 1/60 (2%) using Progressor (p>0.05). Agreement (kappa) was 0.03 within functional measures, and ranged from -0.06 to 0.25 within structural measures, and -0.02 to 0.35 between structural and functional measures. The greatest level of agreement (2 eyes with progression, 52 eyes without progression) was between GDxVCC and SAP VFI (kappa=0.35, p=0.007). Age, corneal thickness, mean IOP, exfoliation or optic disc hemorrhage were not associated with progression using any methodology; SAP PSD was associated with progression using optic disc photography (p=0.04).
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