Elsevier

Ophthalmology

Volume 116, Issue 11, November 2009, Pages 2110-2118
Ophthalmology

Original article
Incidence and Rates of Visual Field Progression after Longitudinally Measured Optic Disc Change in Glaucoma

https://doi.org/10.1016/j.ophtha.2009.04.031Get rights and content

Objective

To determine whether glaucoma patients with progressive optic disc change have subsequent visual field progression earlier and at a faster rate compared with those without disc change.

Design

Prospective, longitudinal, cohort study.

Participants and Controls

Eighty-one patients with open-angle glaucoma.

Methods

Patients underwent confocal scanning laser tomography and standard automated perimetry every 6 months. The complete follow-up was divided into initial and subsequent periods. Two initial periods—first 3 years (Protocol A) and first half of the total follow-up (Protocol B)—were used, with the respective remainder being the subsequent follow-up. Disc change during the initial follow-up was determined with liberal, moderate, or conservative criteria of the Topographic Change Analysis. Subsequent field progression was determined with significant pattern deviation change in ≥3 locations (criterion used in the Early Manifest Glaucoma Trial). As a control analysis, field change during the initial follow-up was determined with significant pattern deviation change in ≥1, ≥2, or ≥3 locations.

Main Outcome Measures

Survival time to subsequent field progression, rates of mean deviation (MD) change, and positive and negative likelihood ratios.

Results

The median (interquartile range) total follow-up was 11.0 (8.0–12.0) years with 22 (18–24) examinations. More patients had disc changes during the initial follow-up compared with field changes. The mean time to field progression was consistently shorter (protocol A, 0.8–1.7 years; protocol B, 0.3–0.7 years) in patients with prior disc change. In the control analysis, patients with prior field change had statistically earlier subsequent field progression (protocol A, 2.9–3.0 years; protocol B, 0.7–0.9). Similarly, patients with either prior disc or field change always had worse mean rates of subsequent MD change, although the distributions overlapped widely. Patients with subsequent field progression were up to 3 times more likely to have prior disc change compared with those without, and up to 5 times more likely to have prior field change compared with those without.

Conclusions

Longitudinally measured optic disc change is predictive of subsequent visual field progression and may be an efficacious end point for functional outcomes in clinical studies and trials in glaucoma.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Section snippets

Patients

The study participants were patients followed prospectively in an investigation on functional and structural changes in glaucoma with a variety of diagnostic tools. Patients were recruited consecutively from the glaucoma clinics of Capital Health District Authority, Halifax, Nova Scotia, Canada. Inclusion criteria were: (1) clinical diagnosis of open-angle glaucoma with notching or progressive thinning of the neuroretinal rim; (2) baseline visual field mean deviation (MD) between −2 and −10 dB;

Results

There were 81 patients who qualified for the study. The median (interquartile range) age and total follow-up was 59.0 (51.2–69.2) and 11.0 (8.0–12.0) years, respectively. The length of follow-up and number of CSLT and SAP examinations for each protocol in the test and control analysis are shown in Table 1. The mean (± standard deviation) MD at baseline was −5.21±3.43 dB, and at the beginning of the subsequent visual field follow-up in protocols A and B was −5.99±3.98 and −6.14±4.63 dB,

Discussion

New imaging devices for the optic disc have the potential to enhance the clinical care of glaucoma patients. Judging the merit of a new imaging technique in glaucoma typically relies on comparison with an accepted clinical methodology, or reference standard, such as conventional photography or clinical examination. For such comparisons, however, there are a priori assumptions that findings with any new technique should be detected, at the same time or in the future, with the reference standard.

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    Manuscript no. 2009-75.

    Supported by Grant MOP11357 from the Canadian Institutes of Health Research (BCC).

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