Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2016 Jun;123(6):1173-80.
doi: 10.1016/j.ophtha.2016.01.039. Epub 2016 Mar 2.

Structural and Functional Progression in the Early Manifest Glaucoma Trial

HannaMaria Öhnell  1 , Anders Heijl  2 , Lena Brenner  3 , Harald Anderson  4 , Boel Bengtsson  2
Affiliations
Randomized Controlled Trial

Structural and Functional Progression in the Early Manifest Glaucoma Trial

HannaMaria Öhnell et al. Ophthalmology. 2016 Jun.

Abstract

Purpose: To elucidate the temporal relationship between detection of glaucomatous optic disc progression, as assessed by fundus photography, and visual field progression.

Design: Prospective, randomized, longitudinal trial.

Participants: Three hundred six study eyes with manifest glaucoma with field loss and 192 fellow eyes without any field defect at the start of the trial, from a total of 249 subjects included in the Early Manifest Glaucoma Trial (EMGT), were assessed.

Methods: Evaluation of visual field progression and optic disc progression during an 8-year follow-up period. Three graders independently assessed optic disc progression in optic disc photographs. Visual field progression was assessed using glaucoma change probability maps and the EMGT progression criterion.

Main outcome measures: Time to detection of visual field progression and optic disc progression.

Results: Among study eyes with manifest glaucoma, progression was detected in the visual field first in 163 eyes (52%) and in the optic disc first in 39 eyes (12%); in 1 eye (0%), it was found simultaneously with both methods. Among fellow eyes with normal fields, progression was detected in the visual field first in 28 eyes (15%) and in the optic disc first in 34 eyes (18%); in 1 eye (1%), it occurred simultaneously.

Conclusions: In eyes with manifest glaucoma, progression in the visual field was detected first more than 4 times as often as progression in the optic disc. Among fellow eyes without visual field loss at baseline, progression was detected first as frequently in the optic disc as in the visual field.

PubMed Disclaimer

Figures

Fig. 2
Fig. 2
Study eyes: Cumulative incidence for visual field and optic disc progression to be detected first for the 306 study eyes, that all had manifest glaucoma with visual field loss. Visual field progression was considerably more common to be detected first. Death occurring within 6 months from the last visit where any progression had not been detected is shown as competing risk. The row below the x-axis denotes the number of eyes still at risk.
Fig. 3
Fig. 3
Fellow eyes: Cumulative incidence for visual field and optic disc progression to be detected first for 192 fellow eyes with no visual field defects at baseline. Visual field and optic disc progression occurred first with similar frequencies. There was no statistically significant difference. Death occurring within 6 months from the last visit where any progression had not been detected is shown as competing risk. The row below the x-axis denotes the number of eyes still at risk.
Figure 4
Figure 4
Graphs showing (A) apparently normal fellow eyes, (B) fellow eyes with ocular hypertension, and (C) preperimetric fellow eyes. Cumulative incidence for visual field and optic disc progression to be detected first (A) for 116 fellow eyes without disc changes or raised intraocular pressure, (B) for 39 ocular hypertensive fellow eyes, and (C) for 37 fellow eyes with preperimetric glaucoma. Fewer progressions were seen in (A) apparently normal fellow eyes without raised intraocular pressure or optic disc changes than in eyes with optic disc signs or elevated intraocular pressure. There was no statistically significant difference for the cumulative incidence between the 2 methods for any of the 3 subgroups. Death occurring within 6 months from the last visit where any progression had not been detected is shown as competing risk. The row below the x-axis in each figure denotes the number of eyes still at risk.
Figure 4
Figure 4
Graphs showing (A) apparently normal fellow eyes, (B) fellow eyes with ocular hypertension, and (C) preperimetric fellow eyes. Cumulative incidence for visual field and optic disc progression to be detected first (A) for 116 fellow eyes without disc changes or raised intraocular pressure, (B) for 39 ocular hypertensive fellow eyes, and (C) for 37 fellow eyes with preperimetric glaucoma. Fewer progressions were seen in (A) apparently normal fellow eyes without raised intraocular pressure or optic disc changes than in eyes with optic disc signs or elevated intraocular pressure. There was no statistically significant difference for the cumulative incidence between the 2 methods for any of the 3 subgroups. Death occurring within 6 months from the last visit where any progression had not been detected is shown as competing risk. The row below the x-axis in each figure denotes the number of eyes still at risk.
Figure 4
Figure 4
Graphs showing (A) apparently normal fellow eyes, (B) fellow eyes with ocular hypertension, and (C) preperimetric fellow eyes. Cumulative incidence for visual field and optic disc progression to be detected first (A) for 116 fellow eyes without disc changes or raised intraocular pressure, (B) for 39 ocular hypertensive fellow eyes, and (C) for 37 fellow eyes with preperimetric glaucoma. Fewer progressions were seen in (A) apparently normal fellow eyes without raised intraocular pressure or optic disc changes than in eyes with optic disc signs or elevated intraocular pressure. There was no statistically significant difference for the cumulative incidence between the 2 methods for any of the 3 subgroups. Death occurring within 6 months from the last visit where any progression had not been detected is shown as competing risk. The row below the x-axis in each figure denotes the number of eyes still at risk.
See this image and copyright information in PMC

Comment in

References

    1. Caprioli J, Prum B, Zeyen T. Comparison of methods to evaluate the optic nerve head and nerve fiber layer for glaucomatous change. Am J Ophthalmol. 1996;121:659–67. - PubMed
    1. Chauhan BC, McCormick TA, Nicolela MT, et al. Optic disc and visual field changes in a prospective longitudinal study of patients with glaucoma. Comparison of scanning laser tomography with conventional perimetry and optic disc photography. Arch Ophthalmol. 2001;119:1492–99. - PubMed
    1. Leung CKS, Liu S, Weinreb RN, et al. Evaluation of retinal nerve fiber layer progression in glaucoma. A prospective analysis with neuroretinal rim and visual field progression. Ophthalmol. 2011;118:1551–7. - PubMed
    1. Banegas SA, Antón A, Morilla-Grasa A, et al. Agreement among spectral-domain optical coherence tomography, standard automated perimetry and stereophotography in the detection of glaucoma progression. Invest Ophthalmol Vis Sci. 2015;56:1253–60. - PubMed
    1. Miglior S, Brigatti L, Lonati C, et al. Correlation between the progression of optic disc and visual field changes in glaucoma. Curr Eye res. 1996;15:145–9. - PubMed

Publication types

MeSH terms

Substances