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J. Ahn, C. Souza, A. L. Coleman, S. K. Law, D. C. Hoffman, J. Caprioli; Comparison of Disc Photographs, Scanning Laser Tomography, and Visual Fields to Identify Progression of Glaucoma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):740.
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© ARVO (1962-2015); The Authors (2016-present)
To compare stereoscopic optic disc photography, confocal scanning laser tomography, and standard automated perimetry to detect glaucoma progression.
In a retrospective longitudinal study, 186 eyes (102 patients) with moderate glaucoma and suspicion of glaucoma were evaluated with optic disc photography (ODP), scanning laser tomography (Heidelberg Retinal Tomography, HRT III), and standard automated perimetry (Humphrey Visual Field Analyzer, HFA) with a follow-up of ≥ 3 years (mean 6.2 ± 1.7 years). Serial images of topographic change analysis (TCA) of HRT III and stereoscopic optic disc photos were independently reviewed and scored by 3 glaucoma specialists (scale from 1 to 5, 1=definite progression, 5=definitely no progression). An average score of < 3 was defined as progression. Visual field progression was defined by change of threshold sensitivity ≤ -1.0 db/year in the presence of p ≤ 0.01 with the two-omitting algorithm at ≥ 1 test location by pointwise linear regression (PLR). Agreement of methods was evaluated by kappa analysis. The change of HRT parameters over follow-up of eyes progressing by ODP evaluation were compared to stable eyes with t-tests.
Mean age was 61.2 ± 10.8 years and average mean deviation was -2.0 ± 4.9 dB at first exam. Progression rates were 24% by ODP, 52% by TCA, and 8% by PLR over follow-up. Kappa between ODP and TCA was 0.14. In eyes that progressed by ODP, 12 of 22 HRT parameters were significantly worse than in eyes without progression. RB discriminant function, cup/disc area ratio, and rim/disc area ratio were the most significant (p < 0.001). Fifty eight percent of eyes progressing by PLR showed progression by TCA and 50% showed agreement with ODP. Thirteen percent of eyes progressing by ODP showed progression by PLR. Seven percent of eyes progressing by TCA showed progression by PLR.
TCA showed the highest rate of progression and had poor agreement with ODP. Few eyes progressing by structural evaluation progressed by visual function. Eyes progressing by ODP had significantly worse HRT parameters compared to stable eyes.
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