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Anne L Coleman, Alessandro Rabiolo, Vahid Mohammadzadeh, Simon K. Law, Joseph Caprioli, Kouros Nouri-Mahdavi; Comparison of Macular and RNFL Rates of Progression in Eyes with Advanced Glaucoma. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5602.
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© ARVO (1962-2015); The Authors (2016-present)
To compare OCT-derived macular and RNFL rates of changes in glaucoma eyes with evidence of central or advanced damage as a function of baseline glaucoma severity.
106 eyes (106 patients) from UCLA’s Advanced Glaucoma Progression Study with ≥2 years of follow-up and ≥5 OCT exams and visual fields (VF) were included. Rates of structural change were estimated by regressing the thickness of outcomes of interest vs. time. To facilitate fair comparison of rates of change, normalized rates were calculated by dividing rates of change by the standard deviation of the regression residuals. Outcomes of interests were global and sectoral (Figure 1) rates of change for full macular thickness (FMT), macular ganglion cell/inner plexiform layer (mGCIPL), and peripapillary RNFL (pRNFL). Rates of change and proportion of worsening and improving sectors (at p<0.05) were compared among the structural outcomes. Analyses were stratified based on 24-2 VF progression status at final follow-up according to pointwise linear regression. Variations in rates of change as a function of baseline thickness were explored.
The median (IQR) baseline VF mean deviation, follow-up time, and number of tests were –6.7 (–12.3 to –4.3) dB, 4.5 (4.1-5.0) years, and 9 (8-10), respectively. The FMT macular sector corresponding to papillomacular bundle (sector D) had the fastest normalized rates of change than most other parameters (p<0.05) followed by rates in pRNFL inferonasal sector (p=0.08), mGCIPL sector D (p=0.10), and global FMT (p=0.13). The FMT macular sector D had also the highest detection rates (62.3%) and lowest false discovery rate (0.0%), followed by FMT global thickness and pRNFL global thickness. Overall, detection rates were highest for FMT, followed by pRNFL and mGCIPL outcomes with a larger difference among the 3 with decreasing baseline thickness. Normalized rates of change were faster in patients with VF progression only for FMT sector F (p=0.03), and mGCIPL sectors C (p=0.046) and F (p=0.02).
FMT measurements had the best performance for detection of change across the spectrum of disease severity with the papillomacular bundle sector most likely to detect worsening with lowest false discovery rate. GCIPL was not superior to pRNFL in this cohort. Our findings confirm the utility of FMT measures in more severe stages of glaucoma.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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