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G. Wollstein, K. Sung, H. Ishikawa, R. A. Bilonick, L. Kagemann, M. L. Gabriele, K. A. Townsend, C. Mattox, J. G. Fujimoto, J. S. Schuman; Detection of Glaucoma Progression With Optical Coherence Tomography Macular Scans. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3336. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the ability of optical coherence tomography (OCT; StratusOCT, Carl Zeiss Meditec, Dublin, CA) macular scans to detect glaucomatous progression over time.
Twenty-eight eyes of glaucoma patients and glaucoma suspects (19 subjects) with at least 4 reliable visual fields (VF) and good quality StratusOCT macular scans were enrolled. VF progression was defined by mean deviation (MD) decrease by 2dB from baseline level (MD criteria-MDC) and by subjective assessment by glaucoma experts (SA). Total macular thickness (TMT) and circumpapillary nerve fiber layer (cNFL) as provided by StratusOCT software were used for the analysis. We also assessed the performance after segmenting the retina into the NFL, ganglion cell layer and the inner plexiform layer (NFL+ IRC) using a software of our own design. A mixed effects model was created to assess the overall slope of changing thickness. The model accounted for scan quality. OCT progression was defined as thinning which exceeded the 95% confidence interval of reported reproducibility error.
Mean baseline VF MD was -6.3±6.9dB and mean final MD was -6.9±6.8dB. The mean follow-up period was 2.8±0.6 years. The overall slope for TMT, NFL+IRC and cNFL showed a negative (thinning) slope for eyes that were defined as progressors by SA and positive slope for those defined as non-progressors. No significant difference was observed between slopes of progressors and non-progressors for the three parameters. Using the progression criteria for each parameter, the survival curve was steepest for NFL+IRC followed by cNFL, and MDC and shallowest for TMT. The difference among the curves was not statistically significant. The agreement among eyes labeled as progressors using the various criteria was poor.
Macular OCT measurements demonstrated change over time but the poor agreement with OCT circumpapillary NFL changes and VF might indicate either a high false positive rate or that the relationship between structural and functional changes may not be temporally coincident.
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