July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Peripapillary RNFL loss precedes Macular GCIPL loss in glaucoma with lower intraocular pressure.
Author Affiliations & Notes
  • Henry Nicholas Marshall
    Department of Ophthalmology, Flinders University, North Adelaide, South Australia, Australia
  • Nicholas H Andrew
    Department of Ophthalmology, Flinders University, North Adelaide, South Australia, Australia
  • Emmanuelle Souzeau
    Department of Ophthalmology, Flinders University, North Adelaide, South Australia, Australia
  • Bronwyn Ridge
    Department of Ophthalmology, Flinders University, North Adelaide, South Australia, Australia
  • Jude Fitzgerald
    Department of Ophthalmology, Flinders University, North Adelaide, South Australia, Australia
  • Mona Awadalla
    Department of Ophthalmology, Flinders University, North Adelaide, South Australia, Australia
  • Kathryn P Burdon
    University of Tasmania, Hobart, South Australia, Australia
  • Paul Healey
    Discipline of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
  • Ashish Agar
    University of New South Wales, Sydney, South Australia, Australia
  • Anna Galanopoulos
    Discipline of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
  • Alex W Hewitt
    University of Tasmania, Hobart, South Australia, Australia
  • Stuart Graham
    Faculty of Medicine and Health Sciences,, Macquarie University, Sydney, New South Wales, Australia
  • John Landers
    Department of Ophthalmology, Flinders University, North Adelaide, South Australia, Australia
  • Robert James Casson
    Discipline of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
  • Jamie E Craig
    Department of Ophthalmology, Flinders University, North Adelaide, South Australia, Australia
  • Footnotes
    Commercial Relationships   Henry Marshall, None; Nicholas Andrew, None; Emmanuelle Souzeau, None; Bronwyn Ridge, None; Jude Fitzgerald, None; Mona Awadalla, None; Kathryn Burdon, None; Paul Healey, None; Ashish Agar, None; Anna Galanopoulos, None; Alex Hewitt, None; Stuart Graham, None; John Landers, None; Robert Casson, None; Jamie Craig, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 3921. doi:https://doi.org/
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    • Get Citation

      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. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : 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).

Methods : 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.

Results : 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.

Conclusions : 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

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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