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Henry Nicholas Marshall, Nicholas H Andrew, Emmanuelle Souzeau, Bronwyn Ridge, Jude Fitzgerald, Mona Awadalla, Kathryn P Burdon, Paul Healey, Ashish Agar, Anna Galanopoulos, Alex W Hewitt, Stuart Graham, John Landers, Robert James Casson, Jamie E Craig; Peripapillary RNFL loss precedes Macular GCIPL loss in glaucoma with lower intraocular pressure.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3921.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To investigate which clinical measures influence whether an individual demonstrates earliest glaucomatous structural progression on peripapillary retinal nerve fibre layer (pRNFL) or macular ganglion cell-inner plexiform layer (mGCIPL).
Design: Prospective longitudinal cohort study.Participants: 271 eyes from 207 individuals with statistically significant evidence of glaucomatous progression on optical coherence tomography (OCT)-Guided Progression Analysis(GPA) software were drawn from a total of 1271 eyes from 686 individuals categorized as glaucoma suspect or having early manifest glaucoma undergoing glaucoma surveillance.Methods: Individuals demonstrating earliest evidence of longitudinal progression on mGCIPL GPA event analysis were compared to individuals demonstrating evidence of earliest longitudinal progression on pRNFL GPA event analysis.
Outcome Measures: Correlation of OCT event change analysis with intra-ocular pressure (IOP) baseline structural and baseline clinical parameters.Results: Eyes demonstrating earliest longitudinal progression on pRNFL had a statistically significantly higher maximum-recorded pre-treatment IOP (mean difference: 3.90mmHg, 95%CI: 2.45-5.33; p<0.001) and mean IOP (mean difference 3.39; 05%CI: 2.23-4.54 p<0.001). The time interval between progression on pRNFL and progression on mGCIPL increased by 12.4 months for every 5mmHg increase in IOP (95%CI: 10.32 -15.72). Eyes with maximum-recorded pre-treatment IOP > 21.5mmHg were 3.31 (95%CI: 1.65-5.50) times more likely to progress first on pRNFL than mGCIPL. Eyes progressing first on mGCIPL parameters were 3.03 (95%CI: 1.26-7.28; p = 0.01) times more likely to develop a paracentral field defect than cases progressing first on pRNFL parameters. Eyes progressing first on pRNFL parameters were 1.79 (95%CI: 1.12-2.86; p = 0.01) times more likely to develop a peripheral field defect than cases progressing first on mGCIPL.
Conclusion: Pre-treatment IOP influences whether structural glaucoma progression is detected first with mGCIPL or pRNFL imaging. The results support the utility of mGCIPL imaging for detecting glaucoma progression and suggest a correlation between IOP, structural progression and functional progression.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
For every increase in IOP of 5mmHg, the interval between pRNFL and mGCIPL progression increases by 12.4months. A positive value indicates pRNFL first progression
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