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Clinical Trial
. 2016 Dec:172:94-103.
doi: 10.1016/j.ajo.2016.09.015. Epub 2016 Sep 17.

Baseline Fourier-Domain Optical Coherence Tomography Structural Risk Factors for Visual Field Progression in the Advanced Imaging for Glaucoma Study

Xinbo Zhang  1 , Anna Dastiridou  2 , Brian A Francis  2 , Ou Tan  1 , Rohit Varma  3 , David S Greenfield  4 , Joel S Schuman  5 , Mitra Sehi  4 , Vikas Chopra  2 , David Huang  6 ; Advanced Imaging for Glaucoma Study Group
Affiliations
Clinical Trial

Baseline Fourier-Domain Optical Coherence Tomography Structural Risk Factors for Visual Field Progression in the Advanced Imaging for Glaucoma Study

Xinbo Zhang et al. Am J Ophthalmol. 2016 Dec.

Abstract

Purpose: To identify baseline structural parameters that predict the progression of visual field (VF) loss in patients with open-angle glaucoma.

Design: Multicenter cohort study.

Methods: Participants from the Advanced Imaging for Glaucoma (AIG) study were enrolled and followed up. VF progression is defined as either a confirmed progression event on Humphrey Progression Analysis or a significant (P < .05) negative slope for VF index (VFI). Fourier-domain optical coherence tomography (FDOCT) was used to measure optic disc, peripapillary retinal nerve fiber layer (NFL), and macular ganglion cell complex (GCC) thickness parameters.

Results: A total of 277 eyes of 188 participants were followed up for 3.7 ± 2.1 years. VF progression was observed in 83 eyes (30%). Several baseline NFL and GCC parameters, but not disc parameters, were found to be significant predictors of progression on univariate Cox regression analysis. The most accurate single predictors were the GCC focal loss volume (FLV), followed closely by NFL-FLV. An abnormal GCC-FLV at baseline increased risk of progression by a hazard ratio of 3.1. Multivariate Cox analysis showed that combining age and central corneal thickness with GCC-FLV in a composite index called "Glaucoma Composite Progression Index" (GCPI) further improved the accuracy of progression prediction. GCC-FLV and GCPI were both found to be significantly correlated with the annual rate of change in VFI.

Conclusion: Focal GCC and NFL loss as measured by FDOCT are the strongest predictors for VF progression among the measurements considered. Older age and thinner central corneal thickness can enhance the predictive power using the composite risk model.

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Figures

Figure 1
Figure 1
Fourier-domain optical coherence tomography scans. Left: optic nerve head (ONH) and peripapillary retinal nerve fiber layer (NFL) scan. Right: macular ganglion complex (GCC) scan.
Figure 2
Figure 2
The number of progressing eyes identified using trend-based analysis and event-based analysis
Figure 3
Figure 3
Kaplan-Meier plot of visual field progression probability in perimetric glaucoma eyes, stratified according to baseline macular ganglion cell complex focal loss volume (GCC FLV) status.
Figure 4
Figure 4
Probability of visual field progression in perimetric glaucoma eyes stratified according to the Glaucoma Composite Progression Index (GCPI) based on a Cox proportional hazard model = glaucoma composite progression index (range 0.1 to 0.9).
See this image and copyright information in PMC

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