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D. Kourkoutas, Y. Buys, J. Flanagan, N. Karamaounas, G. Georgopoulos, E. Iliakis, M. Moschos, G. Trope; The Ability of HRT Topographic Change Analysis to Predict Optic Disc and Visual Field Progression in Patients with Clinically Stable Glaucoma and OHT. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4012.
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To prospectively determine how well progressive optic nerve head(ONH) changes, measured by the Heidelberg Retina Tomograph(HRT) Topographic Change Analysis(TCA), were able to predict the subsequent stereophotographic ONH and/or visual field(VF) deterioration, in clinically stable(at enrolment) patients with glaucoma and OHT.
All patients who had undergone HRT ONH testing, at the Toronto Western Hospital, since 1997, were retrospectively reviewed.From a total of 1200 patients, 92 had available ONH stereophotos and VF tests within 8 months of their first and most recent HRT examination.ONH stereophotos and VFs were evaluated for progression.Eyes showing disease progression either on ONH stereophotos or on VFs were excluded.After this initial evaluation, 78 eyes of 78 patients met the inclusion criteria and were enrolled in the study.Study eyes were classified as TCA-progressed or TCA-stable based on the HRT TCA results.After study enrolment, all eyes underwent testing with HRT, VF and ONH stereophotography at 6 to 9-month intervals.During the retrospective and prospective study period, ONH change on stereophotography was determined by two masked glaucoma specialists. VF progression was defined as "likely progression" based on VF Glaucoma Progression Analysis.
The median total HRT follow-up was 6.9(4.0-11.4) years, which includes a median retrospective and prospective follow-up of 4.2(1.3-8.7) and 2.7(1.2-5.8) years respectively.Stereophotographic ONH and/or VF progression occurred in 3 of 19 TCA-stable patients(15.8%) and in 8 of 59 TCA-progressed patients(13.5%).During the follow-up, 5 patients had ONH changes only, 4 patients had VF changes only and 2 patients had ONH and VF changes.The mean time to VF and/or ONH progression was statistically(p=0.008) shorter in TCA-progressed patients(26.4 months, 95% CI:19.8-33.0 months) than in TCA-stable patients(57.7 months, 95% CI:40.9-74.5 months).TCA-progressed patients were 1.93 times more likely to have stereophotographic ONH change(RR=1.93, 95% CI:0.25-15.05).
Frequency of VF and/or ONH progression was similar between TCA-progressed and TCA-stable patients.TCA ONH change was associated with an earlier clinical glaucoma progression.
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