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Detection of morphological and functional progression in initial glaucoma


Background To observe the prospective follow-up results of functional and morphological data in patients with early, moderate and suspected glaucoma.

Methods Eyes (n=156; average mean defect (MD)=2.2 dB) were examined every 3 months for an average of 3.6 years. Progression was estimated using regression analysis of the indices rim area and Glaucoma Probability Score of the Heidelberg retinal tomograph, mean thickness of the fibre layer using laser polarimetry with corneal compensation, MDs of standard, Pulsar and frequency doubling technology perimetries, and the threshold noiseless trend (TNT) program for the standard and Pulsar perimetries.

Results TNT showed more than twice the diagnostic capacity of other methods. The maximum diagnostic sensitivity was obtained with TNT Pulsar. This procedure indicated progression in 40% of cases after seven examinations, and presented the lowest number of cases of progression not confirmed in two consecutive examinations. Most of the progressions of initial glaucoma were diffuse, without changes in the lens or loss of visual acuity. Heidelberg retinal tomograph and laser polarimetry made few diagnoses of progression. The diagnostic agreement between different methods was low, but higher between functional than morphological procedures.

Conclusion Functional indices, especially Pulsar, showed better detection of progression than morphological indices.

  • Glaucoma
  • morphology
  • optic nerve
  • perimetry
  • progression

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