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Comparative Study
. 2005 Apr;123(4):464-70.
doi: 10.1001/archopht.123.4.464.

Optical coherence tomography longitudinal evaluation of retinal nerve fiber layer thickness in glaucoma

Gadi Wollstein  1 , Joel S Schuman, Lori L Price, Ali Aydin, Paul C Stark, Ellen Hertzmark, Edward Lai, Hiroshi Ishikawa, Cynthia Mattox, James G Fujimoto, Lelia A Paunescu
Affiliations
Comparative Study

Optical coherence tomography longitudinal evaluation of retinal nerve fiber layer thickness in glaucoma

Gadi Wollstein et al. Arch Ophthalmol. 2005 Apr.

Erratum in

  • Arch Ophthalmol. 2005 Sep;123(9):1206

Abstract

Objectives: To longitudinally evaluate optical coherence tomography (OCT) peripapillary retinal nerve fiber layer thickness measurements and to compare these measurements across time with clinical status and automated perimetry.

Methods: Retrospective evaluation of 64 eyes (37 patients) of glaucoma suspects or patients with glaucoma participating in a prospective longitudinal study. All participants underwent comprehensive clinical assessment, visual field (VF) testing, and OCT every 6 months. Field progression was defined as a reproducible decline of at least 2 dB in VF mean deviation from baseline. Progression of OCT was defined as reproducible mean retinal nerve fiber layer thinning of at least 20 mum.

Results: Each patient had a median of 5 usable OCT scans at median follow-up of 4.7 years. The difference in the linear regression slopes of retinal nerve fiber layer thickness between glaucoma suspects and patients with glaucoma was nonsignificant for all variables; however, Kaplan-Meier survival curve analysis demonstrated a higher progression rate by OCT vs VF. Sixty-six percent of eyes were stable throughout follow-up, whereas 22% progressed by OCT alone, 9% by VF mean deviation alone, and 3% by VF and OCT.

Conclusions: A greater likelihood of glaucomatous progression was identified by OCT vs automated perimetry. This might reflect OCT hypersensitivity or true damage identified by OCT before detection by conventional methods.

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Figures

Figure 1
Figure 1
Difference in time between VF test and OCT scan (months).
Figure 2
Figure 2
K-M survival curve for VF-MD and OCT mean RNFL for the entire study group.
Figure 3
Figure 3
Proportion of study patients showing no progression, progression with visual field (VF) only (repeatable VF-MD drop of 2 dB from baseline visit), OCT only (repeatable mean RNFL thickness drop of 20 μm from baseline visit), or both VF and OCT.
Figure 4
Figure 4
K-M survival curves for OCT mean and VF-MD using cutoff of 1, 2 and 4 dB repeatable drop from baseline value for subjects classified as no subjective VF progression (top) and subjective VF progression (bottom).
Figure 5
Figure 5
K-M survival curve for OCT mean and VF-MD in the non-progressor (top) and progressor (bottom) groups as defined by subjective assessment of VF.
Figure 6
Figure 6
Theoretical relationship between structural and functional glaucomatous damage.
See this image and copyright information in PMC

References

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