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Eitan Shemuelian, Gadi Wollstein, Maria de los Angeles Ramos Cadena, Zeinab Ghassabi, TingFang Lee, Jiyuan Hu, Hiroshi Ishikawa, Joel S Schuman, Fabio Lavinsky; Can the Inner Nuclear Layer Thickness Help Detect Progression in Advanced Glaucoma?. Invest. Ophthalmol. Vis. Sci. 2022;63(7):4261.
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© ARVO (1962-2015); The Authors (2016-present)
The ability to detect progression in eyes with advanced glaucoma is challenging because of known limitations of commonly used structural and functional parameters reaching their minimal measurable limit (floor effect) or increased measurement variability. We examined the ability of inner nuclear layer (INL) thickness measurements to demonstrate change longitudinally in eyes with early and advanced severity glaucoma.
Subjects with glaucoma and ≥4 visits were included in the study. Subjects in the “Early/Moderate” group (EG) had average circumpapillary retinal nerve fiber layer (cRNFL) thicknesses ≥60µm and subjects in the “Advanced” group (AG) had average cRNFL thicknesses ≤60µm. All subjects had comprehensive ophthalmic examination, Humphrey visual field (Zeiss, Dublin, CA) testing, and spectral-domain OCT (Cirrus HD-OCT; Zeiss) optic nerve head (ONH) and macula scans. Segmentation of the INL was performed using the Iowa Reference Algorithms (Retinal Image Analysis Lab, Iowa Institute for Biomedical Imaging, Iowa City, IA) and segmentation errors were manually corrected by a trained grader. Overall INL thickness along with the superior and inferior hemifields were used for analysis. Rates of progression were estimated from longitudinal OCT and visual field (VF) data using mixed effects models adjusting for baseline age, follow-up duration, and signal strength at each visit.
23 eyes (23 subjects), 12 with EG and 11 with AG, were included in the study. At baseline, a statistically significant difference between groups was detected in MD, cRNFL, and GCIPL thicknesses (Table 1). In EG eyes, the rate of change was significantly different than a zero slope for cRNFL thickness, C:D ratio, and GCIPL thickness (Table 2). Inferior INL thickness was the only INL parameter showing significant rate of change. However, in the advanced group, all parameters (including both global and sectoral INL thicknesses) showed significant rate of change except for the cRNFL.
Longitudinal measurements of INL thickness may be useful for following disease progression in subjects with advanced-stage glaucoma where cRNFL thickness is no longer useful.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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