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Abstract
Background To examine long-term retinal nerve fibre layer thickness (RNFLT) variability and associated clinical factors in African (AD) and European descent (ED) individuals with glaucoma.
Methods This retrospective cohort study included glaucoma eyes of AD and ED from Diagnostic Innovations in Glaucoma Study/The African Descent and Glaucoma Evaluation Study with ≥4 visits/2 years of follow-up. We calculated optic nerve head RNFLT variability per-examination/visit as the absolute error of its residuals across follow-up. Full, baseline and parsimonious linear-mixed models were fit to evaluate the effects of clinical factors (demographics and ocular characteristics, prior/intervening glaucoma surgeries and cataract extraction (CE), RNFLT thinning rate, scan quality, visit/testing frequency, etc) on RNFLT variability in both races.
Results There were 376 and 625 eyes (226 and 349 participants) of AD and ED, and the mean (95% CI) RNFLT variability was 1.62 (1.52, 1.71) µm and 1.42 (1.34, 1.50) µm, respectively (p=0.002). AD and ED had some shared predictors of RNFLT variability, including intraocular pressure fluctuation and scan quality, although the effects varied (p<0.05). In both races, intervening CE was most strongly correlated with higher RNFLT variability (β: 0.24–0.92, p<0.05). After excluding eyes with intervening CE, RNFLT variability was reduced and the small racial difference was no longer significant (AD: 1.40 (1.31, 1.48) µm vs ED: 1.34 (1.27, 1.40) µm; p=0.280).
Conclusions Although some predictors were identified, long-term RNFLT variability appeared small for both AD and ED eyes. Moreover, the racial difference did not remain once intervening CE, the strongest predictor of variability, was eliminated. Our findings inform on strategies to optimise structural assessment and suggest that, when accounting for relevant factors, RNFLT is reliable across races.
- glaucoma
Data availability statement
Data are available upon reasonable request. Data are available on reasonable request. The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.
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Data availability statement
Data are available upon reasonable request. Data are available on reasonable request. The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.
Footnotes
J-HW and SM are joint first authors.
J-HW and SM contributed equally.
Contributors Concept and design—J-HW, SM, EW, TN and LMZ. Acquisition and reviewing of data—J-HW, SM, EW, TN and LMZ. Analysis or interpretation of data—J-HW, SM, EW, TN, JML, MAF, CAG, LMZ and RNW. Drafting of the manuscript—J-HW, SM and EW. Critical revision of the manuscript—J-HW, SM, EW, TN, JML, MAF, CAG, LMZ and RNW. Obtained funding—SM, JML, MAF, CAG, LMZ and RNW. Supervision—SM, LMZ and RNW. Guarantor—RNW.
Funding This work is supported by National Institutes of Health/National Eye Institute Grants (R01EY029058, R01EY011008, R01EY019869, R01EY027510, R01EY026574, R01EY018926, R01EY034148, Core Grant P30EY022589); University of California Tobacco Related Disease Research Program (T31IP1511) and an unrestricted grant from Research to Prevent Blindness (New York, New York, USA).
Competing interests SM reported grants from the National Eye Institute. TN is a consultant for Topcon. JML is a consultant to Alcon, Genetech, Thea, Allergan, Carl Zeiss Meditech and AdvanceSight. MAF reported grants from the National Eye Institute, Topcon and Heidelberg Engineering; and non-financial support from Wolfram Research. CAG reported research support from Topcon and Heidelberg Engineering. LMZ reported grants from the National Eye Institute and Heidelberg Engineering; non-financial support from Optovue, Heidelberg Engineering, Carl Zeiss Meditec and Topcon; and patents to AiSight Health and Carl Zeiss Meditec. LMZ is a consultant of AbbVie and Topcon. RNW is a consultant of AbbVie, Equinox Alcon, Allergan, Eyenovia, Iantrek, Amydis, IOPtic, Nicox, Santen, Implandata and Topcon. RNW reported non-financial support from Carl Zeiss Meditec, Optovue, Heidelberg Engineering, Topcon and Centervue; grants from the National Institute of Minority Health Disparities, National Eye Institute and Research to Prevent Blindness; and patents from Toromedes, Carl Zeiss Meditec to UCSD, all outside the submitted work.
Provenance and peer review Not commissioned; externally peer reviewed.
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