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Observational Study
. 2014 Jul;121(7):1350-8.
doi: 10.1016/j.ophtha.2014.01.017. Epub 2014 Mar 13.

Rates of retinal nerve fiber layer thinning in glaucoma suspect eyes

Atsuya Miki  1 , Felipe A Medeiros  2 , Robert N Weinreb  2 , Sonia Jain  3 , Feng He  3 , Lucie Sharpsten  2 , Naira Khachatryan  2 , Na'ama Hammel  2 , Jeffrey M Liebmann  4 , Christopher A Girkin  5 , Pamela A Sample  2 , Linda M Zangwill  6
Affiliations
Observational Study

Rates of retinal nerve fiber layer thinning in glaucoma suspect eyes

Atsuya Miki et al. Ophthalmology. 2014 Jul.

Abstract

Purpose: To compare the rates of retinal nerve fiber layer (RNFL) loss in patients suspected of having glaucoma who developed visual field damage (VFD) with those who did not develop VFD and to determine whether the rate of RNFL loss can be used to predict the development of VFD.

Design: Prospective, observational cohort study.

Participants: Glaucoma suspects, defined as having glaucomatous optic neuropathy or ocular hypertension (intraocular pressure, >21 mmHg) without repeatable VFD at baseline, from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study.

Methods: Global and quadrant RNFL thickness (RNFLT) were measured with the Spectralis spectral-domain optical coherence tomography (SD-OCT; Spectralis HRA+OCT [Heidelberg Engineering, Heidelberg, Germany]). Visual field damage was defined as having 3 consecutive abnormal visual fields. The rate of RNFL loss in eyes developing VFD was compared to eyes not developing VFD using multivariate linear mixed-effects models. A joint longitudinal survival model used the estimated RNFLT slope to predict the risk of developing VFD, while adjusting for potential confounding variables.

Main outcome measures: The rate of RNFL thinning and the probability of developing VFD.

Results: Four hundred fifty-four eyes of 294 glaucoma suspects were included. The average number of SD-OCT examinations was 4.6 (range, 2-9), with median follow-up of 2.2 years (0.4-4.1 years). Forty eyes (8.8%) developed VFD. The estimated mean rate of global RNFL loss was significantly faster in eyes that developed VFD compared with eyes that did not develop VFD (-2.02 μm/year vs. -0.82 μm/year; P<0.001). The joint longitudinal survival model showed that each 1-μm/year faster rate of global RNFL loss corresponded to a 2.05-times higher risk of developing VFD (hazard ratio, 2.05; 95% confidence interval, 1.14-3.71; P = 0.017).

Conclusions: The rate of global RNFL loss was more than twice as fast in eyes that developed VFD compared with eyes that did not develop VFD. A joint longitudinal survival model showed that a 1-μm/year faster rate of RNFLT loss corresponded to a 2.05-times higher risk of developing VFD. These results suggest that measuring the rate of SD-OCT RNFL loss may be a useful tool to help identify patients who are at a high risk of developing visual field loss.

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Conflict of interest statement

Conflict of Interest: No Disclosure (LS, PAS, NK, SJ, NH, HF)

Figures

Figure 1
Figure 1
Distribution of the rates of global retinal nerve fiber layer loss in eyes that developed visual field damage (upper panel) and in eyes that did not develop visual field damage (lower panel).
Figure 2
Figure 2
Predicted survival curves for two eyes, one that showed a fast rate of retinal nerve fiber layer loss (right panel) and one that showed a stable measurements over time (left panel). Slopes are given as μm/year. A comparison of the predicted survival probabilities shows that the eye with fast progression had lower predicted probabilities of survival (i.e., retaining a normal visual field). The eye with a fast rate of loss in fact showed development of visual field damage during follow-up whereas the eye with stable measurements did not. RNFL: retinal nerve fiber layer. VFD: visual field damage
See this image and copyright information in PMC

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