Abstract
Purpose :
To compare Trend-based Progression Analysis (TPA) of RNFL thickness versus TPA of RNFL optical texture in detecting progression and predicting visual field (VF) loss in patients with primary open angle glaucoma (POAG) or ocular hypertension (OHT).
Methods :
773 eyes of 423 patients with POAG (735 eyes of 400 patients) or OHT (38 eyes of 23 patients), and 167 eyes of 106 healthy individuals were consecutively recruited for VF testing and optical coherence tomography RNFL imaging at 4-month intervals over 36.0 months. Progressive RNFL thinning and progressive RNFL optical texture loss were determined by TPA; VF progression was determined by the EMGT criteria. The hazard ratios (HR) for development of VF progression were evaluated using time-varying Cox proportional hazard modeling in eyes with mild glaucoma (VF MD>-6dB) and in eyes with moderate to advanced glaucoma (VF MD≤-6dB). The specificities were determined from the healthy group. The methods of TPA and ROTA are described in Ophthalmology. 2016;123:1201-10 and Nat Biomed Eng. 2022;6:593-604, respectively.
Results :
At the baseline visit, 56.5% had early glaucoma and 43.5% had moderate to severe glaucoma in the POAG/OHT group. Over 36 months of follow-up, 12.4% of eyes developed VF progression, 13.6% developed progressive RNFL thinning, and 45.7% developed progressive RNFL optical texture loss. Progressive RNFL optical texture loss developed earlier than progressive RNFL thinning by an average of 6 months. Eyes with progressive RNFL thinning (HR: 1.78, 95% CI: 1.06-2.98), or progressive RNFL optical texture loss (HR: 2.29, 95% CI: 1.52-3.45, P<0.001) had a higher risk of subsequent development of VF progression. Progressive RNFL optical texture loss, but not progressive RNFL thinning, remained predictive of VF progression in eyes with moderate to advanced glaucoma (HR: 3.00, 95% CI: 1.33-6.74, P=0.008), after adjusting for intraocular pressure levels, age, axial length, and baseline VF severity (MD). The specificity was 98.8% (95% CI: 95.7-99.7%) for TPA of RNFL thickness, and 91.6% (95% CI: 86.4-94.9%) for TPA of RNFL optical texture.
Conclusions :
ROTA detected progressive RNFL loss in glaucoma missed by conventional RNFL thickness analysis. Eyes with progressive RNFL optical texture loss, but not those with progressive RNFL thinning, predicted VF progression in moderate to advanced glaucoma.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.