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R. H. Kardon, D. Hood, Q. Ghadiali, A. Raza, S. Anderson, C. Doyle, K. Woodward, M. Wall; The Search for Glaucomatous Progression in both Structure and Function in the Same Eyes Using Optical Coherence Tomography (OCT) and Standard Automated Perimetry (SAP). Invest. Ophthalmol. Vis. Sci. 2009;50(13):2570.
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To compare evidence for glaucomatous progression based upon changes in structural and functional tests. Changes over time in retinal nerve fiber layer (RNFL) thickness on optical coherence tomography (OCT) and visual sensitivity on standard automated perimetry (SAP) were analyzed.
Two groups were compared: (1) normal eyes (n=44) and (2) glaucoma eyes with mean deviation on SAP of better than -20 dB (n=83). Both groups were retested every 6 months over 4 years. All eyes were tested by Stratus OCT3 and SITA 24-2 SAP. For each eye, linear regression analysis of RNFL and visual field sensitivity vs. time was performed for the averaged locations within superior and inferior arcuate regions and for the average of all locations. From the distribution of slopes derived from normal eyes, ±2 standard deviations limits were calculated in order to determine which glaucoma eyes had abnormal positive (improvement) or negative (progression) slopes.
The table shows the number of patient eyes with abnormal slope values. There were more abnormal eyes, both progressing and improving, on SAP as compared to OCT. There was SAP-OCT agreement in significant progression in only 1 eye and in improvement in 2 eyes. There was a weak, but significant, correlation in slope for SAP vs. OCT in the same eyes (R=0.16, p=0.03). Neither the severity of damage nor the variability (SD) of SAP and OCT measurements over time significantly correlated with slope.
A greater proportion of eyes showed evidence for progression (i.e. a significantly abnormal negative slope) and improvement by SAP as compared to OCT. Further, only one eye showed evidence for progression (significant slopes) on both tests. We are currently investigating reasons that might explain why testing of visual field function (SAP) defined more cases of significant change over time than testing of structure (RNFL by OCT).
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