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Ryan Caezar Calaguas David, Sasan Moghimi, Eren Ekici, Jiun Lap Do, Huiyuan Hou, James A Proudfoot, Alireza Kamalipour, Takashi Nishida, Christopher A Girkin, Jeffrey M Liebmann, Robert N Weinreb; Rates of RNFL thinning in distinct glaucomatous optic disc phenotypes in early glaucoma. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1832.
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© ARVO (1962-2015); The Authors (2016-present)
To compare spectral-domain optical coherence tomography (SDOCT) measured circumpapillary retinal nerve fiber layer (cpRNFL) among four glaucomatous optic disc phenotypes in early glaucoma.
In this longitudinal study, 218 early glaucoma eyes that had at least 3 years of follow-up and a minimum of 4 SDOCT scans were recruited from the Diagnostic Innovations in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES). The optic discs were classified into four types based on appearance: generalized cup enlargement (GE), focal ischemic (FI), myopic glaucomatous (MY), and senile sclerotic (SS). A linear mixed-effect model was used to compare the rates of global and regional cpRNFL thinning among optic disc phenotypes.
Of the 218 early glaucoma eyes that were followed for an average of 5.9 years, 76 were classified as generalized cup enlargement (GE), 53 focal ischemic (FI), 22 myopic glaucomatous (MY), and 67 senile sclerotic (SS) discs. After adjusting for confounders, the SS group (mean (95% CI): -1.01 (-1.30, -0.73) µm/year) had the fastest mean rate of global cpRNFL thinning followed by FI (-0.77 (-0.97, -0.57) µm/year), MY (0.59 (-0.81, -0.36) µm/year) and GE (-0.58 (-0.75, -0.40) µm/year) at p<0.001. The inferior temporal sector had the fastest mean rate of cpRNFL thinning among the regional measurements except for the MY group (-0.68 (-1.10, -0.26) µm/year), p=0.002). In the multivariable analysis, higher mean intraocular pressure during follow-up (p<0.001) and optic disc phenotype (p=0.014) were associated with faster cpRNFL thinning. The GE (p=0.002) and MY (p=0.010 ) phenotypes were associated with significantly slower global rates of cpRNFL thinning when compared to the SS phenotype.
Rates of cpRNFL thinning were different among the four glaucomatous optic disc phenotypes. Those patients with early glaucoma with SS phenotype have the fastest cpRNFL thinning. These patients may benefit from more frequent monitoring and the need to advance therapy if cpRNFL thinning is detected.
This is a 2021 ARVO Annual Meeting abstract.
Figure 1. Diagrams showing estimated mean rates of circumpapillary retinal nerve fiber layer (cpRNFL) thinning for generalized cup enlargement (GE), focal ischemic (FI), myopic glaucomatous (MY) and senile sclerotic (SS) eyes in early glaucoma (24-2 VF MD>-6 dB). Data are presented as cpRNFL change rate (µm/year).
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