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Devon Joiner, Xinhui Li, Melvi Eguia, Emmanouil (Manos) Tsamis, Ashley Sun, C Gustavo De Moraes, Robert Ritch, Donald C Hood; Detecting progression of preserved areas of retinal nerve fiber layer in advanced glaucoma using optical coherence tomography. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5547.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the feasibility of using optical coherence tomography (OCT) to follow eyes with advanced glaucoma, local regions of preserved circumpapillary retinal nerve fiber layer (cpRNFL) were followed and compared to more global measures.
Participants had a mean deviation (MD)≤-12 dB on a 24-2 visual field (VF) and 2 spectral domain (SD) OCT imaging sessions with 3.5mm circle scans of the disc placed in the same location by the commercial software. 30 eyes from 26 patients were included, age 61.8±15.9 yrs [range: 18.1 to 79.5] with OCT scans 1.7±0.7 yrs apart [0.8 to 3.3]. Progression was assessed first with summary metrics including global and sectoral cpRNFL thickness (Table). Second, regions of interest (ROIs)1 were marked manually (mROI) for local areas of preserved cpRNFL on the circle scans and automatically (aROI) based on areas in yellow and green on cpRNFL thickness plots.2 The results were analyzed with linear mixed model regression.
29 of 30 eyes had preserved regions of RNFL in the temporal half of the disc that could be followed. None of the 4 summary metrics showed significant changes between visits (Table). On the other hand, both mROI width and aROI thickness showed significant decreases (asterisk in Table). The mROI width and aROI thickness had a mean change of -177±285μm (p=0.002) and -3.3±6.2μm (p=0.007), respectively. See example of circle scans in fig. 1 with yellow lines highlighting mROIs and decreases in width 2.5 years later shown in red.
OCT circle scans can be used to follow progression in eyes with advanced glaucoma if local regions of preserved cpRNFL are measured via either manual or automated methods. On the other hand, summary metrics did not perform well, though may be useful when larger portions of cpRNFL remain. This highlights the importance of careful inspection of the B-scan and demonstrates the utility of OCT for monitoring progression even when the VF MD and RNFL global thickness are low.1. Hood DC et al. JAMA Ophthalmol. 2015;133:1438; 2. Wu Z et al. TVST. 2018;7(1):19.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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