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L.S. Kim, J.M. Wild, I.A. Cunliffe, S.A. Hancock; Longitudinal Changes in Function and Structure in Primary Open Angle Glaucoma and Ocular Hypertension . Invest. Ophthalmol. Vis. Sci. 2003;44(13):66.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To determine the prevalence of glaucomatous progressive functional damage by W-W perimetry and FDT perimetry and of glaucomatous progressive structural damage by HRT, OCT and Sequential Stereophotography. Methods: Twenty-three patients with POAG (mean age 68.8 years, SD 9.8) and 9 patients with OHT (68.7 years, SD 13.9) were examined with a mean time to follow-up of 25.9 months (SD 5.6 months). At the baseline and follow-up examination, patients attended 4 visits of alternate visual field and imaging sessions. At one visit, W-W perimetry was undertaken on the designated eye of each patients with the Humphrey Field Analyzer 750 using Full-Threshold Program 24-2 and FDT perimetry Full Threshold Program C-20. At the alternate imaging visits, the mean of three HRT images and the mean of five OCT images of the retinal nerve fibre layer (RNFL) were acquired. Visual field progression (VFP) for W-W perimetry was analyzed by Glaucoma Change Probability Analysis and designated as deterioration at each of the two successive follow-up visits. VFP for FDT was designated as a worsening by at least one probability level on the Total Deviation plot from the initial examination confirmed at each of the two successive follow-up visits. Progression in optic disc topography was anlayzed by Progression Analysis (PA) using the HRT II. Attenuation in the RNFL was defined as the 95th percentile of the lower limits of agreement for the first and second imaging visits at the baseline examination for the OHT patients and for the POAG patients. An experienced fellowship-trained glaucoma specialist (IAC), masked to patient identity, evaluated the ONH photographs at follow-up for the presence of progressive glaucomatous damage. Results: Twenty-one patients with POAG (95.5%) and three patients with OHT (37.5%) showed progression by HRT PA. Of these, 6 patients with POAG exhibited VFP by W-W perimetry and by FDT perimetry, 1 patient with POAG exhibited VFP by W-W perimetry, only, and 4 patients with POAG exhibited VFP by FDT periemtry, only. Of the 3 patients with OHT, none exhibited VFP by W-W perimetry or FDT perimetry. RNFL progression could not be detected by OCT. Conclusions: Apparent glaucomatous progression was detected most frequently by the HRT PA than by OCT or by observation of photographs. FDT perimetry detected apparent glaucomatous VFP more frequently than W-W perimetry.A combination of the HRT PA and FDT perimetry would seemingly improve the ability to detect progressive glaucomatous damage.
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