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. 2025 Nov;39(16):2986-2991.
doi: 10.1038/s41433-025-04021-8. Epub 2025 Sep 22.

Initial circumpapillary retinal nerve fibre layer rates of change predict glaucomatous progression

Vincent Q Pham  1 , Takashi Nishida  1 , Sasan Moghimi  1 , Naimul Alam  1 , Christopher A Girkin  2 , Massimo A Fazio  2 , Jeffrey M Liebmann  3 , Linda M Zangwill  1 , Robert N Weinreb  4
Affiliations

Initial circumpapillary retinal nerve fibre layer rates of change predict glaucomatous progression

Vincent Q Pham et al. Eye (Lond). 2025 Nov.

Abstract

Objectives: To investigate whether the rate of circumpapillary retinal nerve fibre layer (cpRNFL) change during initial follow-up can predict event progression detected by guided progression analysis (GPA) over an extended follow-up.

Methods: Primary open-angle glaucoma (POAG) and glaucoma suspect patients with a minimum of seven optical coherence tomography (OCT) scans were analysed. The cpRNFL slopes were calculated for an initial follow-up of 2, 3, 4, and 5 visits (6 months apart for each visit) using a linear mixed-effects model. After the initial follow-up, the event date was then marked as the date of the first OCT test that indicated likely progression using GPA software. The cumulative risk of progression in slow (>-1.0 µm/year) vs moderate-and-fast (≤-1.0 µm/year) initial OCT slopes was compared using Kaplan-Meier survival analysis and log-rank test for the optimal scenarios.

Results: The study included 472 eyes (340 POAG and 132 glaucoma suspects) from 307 patients. The optimal scenario for predicting GPA progression over the ensuing 3 years included the initial 4 OCT sessions (the adjusted-HR = 1.76 (95% CI: 1.37-2.26) per initial 1 μm/faster; P < 0.001. For predicting progression over the next 5 years, the optimal scenario included the initial 5 OCT sessions that occurred for the first 2 years. The adjusted-HR was 1.65 (95% CI: 1.16-2.33) per initial 1 μm/faster; P = 0.005.

Conclusions: The rate of initial cpRNFL change observed within half the monitoring period may effectively predict the subsequent structural progression and can be used by clinicians to predict the course of glaucoma when monitoring patients.

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Conflict of interest statement

Competing interests: TN is a consultant of Topcon. SM reported grants from the National Eye Institute and University of California Tobacco-Related Disease Research Program. CAG reported grants from the National Eye Institute, EyeSight Foundation of Alabama, and Research to Prevent Blindness, and nonfinancial support from Heidelberg Engineering and Topcon. CAG is a consultant of Iridex and Topcon. MAF reported grants from the National Eye Institute, Research to Prevent Blindness, and Wolfram Research, and nonfinancial support Heidelberg Engineering and Topcon. JML is a consultant of Alcon, Abbvie, AdvanceSight, Carl Zeiss Meditech, Genentech, and Thea. JML reported grants and financial support from Novartis, Research to Prevent Blindness, National Eye Institute, and Research to Prevent Blindness. LZ reported grants from the National Eye Institute; grants from Heidelberg Engineering and nonfinancial support from Carl Zeiss Meditec, Optovue, Heidelberg Engineering, and Topcon. Consultant of Abbvie, AISight Health and Topcon and patents from Carl Zeiss Meditec. RNW is a consultant of Abbvie, Alcon, Amydis, Eyenovia, Iantrek, Implandata, Spinogenix, Toku and Topcon. RNW reported nonfinancial support from Heidelberg Engineering, Carl Zeiss Meditec, Konan Medical, Optovue, Centervue, and Topcon; grants from the National Eye Institute and National Institute of Minority Health Disparities, patents from Toromedes, Carl Zeiss Meditec to UCSD; all outside the submitted work. No other disclosures were reported.

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