Elsevier

Ophthalmology

Volume 118, Issue 8, August 2011, Pages 1551-1557
Ophthalmology

Original article
Evaluation of Retinal Nerve Fiber Layer Progression in Glaucoma: A Prospective Analysis with Neuroretinal Rim and Visual Field Progression

https://doi.org/10.1016/j.ophtha.2010.12.035Get rights and content

Objective

To evaluate the performance of progression detection and the rate of change of retinal nerve fiber layer (RNFL), neuroretinal rim, and visual field measurements in glaucoma.

Design

Prospective study.

Participants

One hundred eight eyes of 70 glaucoma patients.

Methods

Patients were followed up every 4 months for at least 2.9 years (median, 3.2 years) for measurement of RNFL thickness with the Stratus optical coherence tomograph (OCT) (Carl Zeiss Meditec, Dublin, CA), neuroretinal rim area with the Heidelberg Retinal Tomograph (HRT 3; Heidelberg Engineering, GmbH, Dossenheim, Germany), and visual field with the Humphrey Field Analyzer II (Carl Zeiss Meditec). Linear regression analyses were performed between visual field index (VFI), RNFL, and neuroretinal rim measurements and age, with progression defined when a significant negative trend was detected. The agreement among structural and functional measurements was evaluated with κ statistics. The mean rate of change was estimated with linear mixed modeling.

Main Outcome Measures

The agreement on progression detection and the rate of change of RNFL, neuroretinal rim, and VFI measurements.

Results

A total of 1105 OCT, 1062 HRT, and 1099 visual field measurements were analyzed. The agreement of progression detection among the 3 investigations was poor (κ≤0.09). Ten eyes (9.3%; 9 patients) showed progression by average RNFL thickness, 16 (14.8%; 14 patients) by global neuroretinal rim area, and 35 (32.4%; 31 patients) by VFI. Only 1 eye (0.9%) had progression detected by all 3 methods. There were large variations in the rate of change of VFI, average RNFL thickness, and global neuroretinal rim area, with a range between −0.63% and −4.97% per year, −2.32% and −10.12% per year, and −0.61% and −8.48% per year, respectively. The respective mean rate estimates were −1.15% per year (95% confidence interval [CI], −1.56% to −0.73%), −0.70% per year (95% CI, −1.19% to −0.21%), and −1.06% per year (95% CI, −1.56% to −0.55%).

Conclusions

The agreement of progression detection among RNFL, neuroretinal rim, and visual field measurements was poor, and the rate of RNFL, neuroretinal rim, and visual field progression varied considerably within and between subjects. Given this variability, interpretation of RNFL, neuroretinal rim, and VFI progression always should be evaluated on an individual basis.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Patients

One hundred eight eyes from 70 glaucoma patients followed up from November 2005 through March 2010 were included. At the baseline examination, all subjects underwent a full ophthalmic examination, including visual acuity, refraction, intraocular pressure measurement with Goldmann tonometry, gonioscopy, and fundus examination. The inclusion criteria were best-corrected visual acuity of not worse than 20/40 and spherical refractive error between −10.0 and +6.0 diopters (D) with less than 5.0 D of

Results

One hundred eight eyes from 70 glaucoma patients were followed up prospectively every 4 months for at least 2.9 years (median, 3.2 years; range, 2.9–3.9 years) with RNFL, neuroretinal rim, and visual field measured at each visit. There were a total of 1105 observations for OCT, 1062 for HRT III, and 1099 for visual field, with an average of 10.2±0.8, 9.8±1.0, and 10.2±0.8 observations available for each eye for analyses. At baseline, 27.7% (30 eyes) had advanced glaucoma (MD<–12 dB), 29.6% (32

Discussion

To the best of the authors' knowledge, this is the first study prospectively comparing the performance of progression detection and the rate of RNFL, neuroretinal rim, and visual field progression in patients with glaucoma. In contrast to a retrospective design in which the follow-up duration, frequency, and number of investigations may vary considerably among patients, all subjects analyzed in this prospective study were followed up every 4 months, with investigations performed using a

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    Manuscript no. 2010-655.

    Financial Disclosure(s): The author(s) have made the following disclosure(s): Christopher Kai Shun Leung - Financial support - Carl Zeiss MeditecRobert Neal Weinreb - Consultant and Financial support - Carl Zeiss Meditec

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