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Comparative Study
. 2017 Dec:184:63-74.
doi: 10.1016/j.ajo.2017.09.020. Epub 2017 Sep 28.

Comparison of Glaucoma Progression Detection by Optical Coherence Tomography and Visual Field

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

Comparison of Glaucoma Progression Detection by Optical Coherence Tomography and Visual Field

Xinbo Zhang et al. Am J Ophthalmol. 2017 Dec.

Abstract

Purpose: To compare longitudinal glaucoma progression detection using optical coherence tomography (OCT) and visual field (VF).

Design: Validity assessment.

Methods: We analyzed subjects with more than 4 semi-annual follow-up visits (every 6 months) in the multicenter Advanced Imaging for Glaucoma Study. Fourier-domain optical coherence tomography (OCT) was used to map the thickness of the peripapillary retinal nerve fiber layer (NFL) and ganglion cell complex (GCC). OCT-based progression detection was defined as a significant negative trend for either NFL or GCC. VF progression was reached if either the event or trend analysis reached significance.

Results: The analysis included 356 glaucoma suspect/preperimetric glaucoma (GS/PPG) eyes and 153 perimetric glaucoma (PG) eyes. Follow-up length was 54.1 ± 16.2 months for GS/PPG eyes and 56.7 ± 16.0 for PG eyes. Progression was detected in 62.1% of PG eyes and 59.8% of GS/PPG eyes by OCT, significantly (P < .001) more than the detection rate of 41.8% and 27.3% by VF. In severity-stratified analysis of PG eyes, OCT had significantly higher detection rate than VF in mild PG (63.1% vs. 38.7%, P < .001), but not in moderate and advanced PG. The rate of NFL thinning slowed dramatically in advanced PG, but GCC thinning rate remained relatively steady and allowed good progression detection even in advanced disease. The Kaplan-Meier time-to-event analyses showed that OCT detected progression earlier than VF in both PG and GS/PPG groups.

Conclusions: OCT is more sensitive than VF for the detection of progression in early glaucoma. While the utility of NFL declines in advanced glaucoma, GCC remains a sensitive progression detector from early to advanced stages.

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Figures

Figure 1
Figure 1
An example of glaucoma progression detection using trend analysis of visual field index (VFI), peripapillary retinal nerve fiber layer (NFL) thickness, and macular ganglion cell complex (GCC) thickness in a perimetric glaucoma (PG) eye. Progression is detect as a significant trend (negative linear regression slope with p<0.05) at an earliest visit by GCC, followed by NFL and then NFL.
Figure 2
Figure 2
Venn diagram of glaucoma progression detection in perimetric glaucoma eyes using various methods. The visual field (VF) methods include the visual field event analysis by Guided Progression Analysis (GPA) and the visual field trend analysis. The optical coherence tomography (OCT) methods include analysis of thinning trend in macular ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (NFL).
Figure 3
Figure 3
Venn diagram of glaucoma progression detection in the glaucoma suspect & pre-perimetric glaucoma group. The visual field (VF) methods include the visual field event analysis by Guided Progression Analysis (GPA) and the visual field trend analysis. Optical coherence tomography (OCT) progression was established by significant thinning trend in either macular ganglion cell complex (GCC) or peripapillary nerve fiber layer (NFL).
Figure 4
Figure 4
Kaplan-Meier plots of glaucoma progression detected by OCT and by visual field among pre-perimetric glaucoma eyes.
Figure 5
Figure 5
Kaplan-Meier plots of glaucoma progression detected by OCT and by visual field among glaucoma suspect/pre-perimetric glaucoma eyes.
See this image and copyright information in PMC

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