Purpose
To determine the clinical features of optic disc progression in patients with ocular hypertension and early glaucoma.
Patients
336 eyes of 168 patients with ocular hypertension or early glaucoma
Methods
Two glaucoma specialists independently graded the baseline and most recent optic disc photographs for optic disc progression. Optic disc progression was defined as: new or increased neuroretinal rim thinning (two or more clock hours), notching (one clock hour or less of thinning of the neuroretinal rim), excavation (undermining of the neuroretinal rim or disc margin), and nerve fiber layer defect(s). They also determined the location of these changes.
Results
Ninety-two of 336 eyes (27.4%) showed optic disc progression after a median of 6.1 years. Of those with progression, excavation occurred in 89% of eyes; rim thinning occurring in 54%; and notching occurring in 16%. Fifty-six percent (56%) had two or more features of progression. The inferotemporal quadrant was the most common location for progression, but more than one location of progression occurred in at least 30% of eyes with progression.
Conclusions
Optic disc progression occurred frequently in this cohort of ocular hypertension and early glaucoma patients. When evaluating the optic disc for glaucomatous progression, eye care providers should pay particular attention to increased excavation and neuroretinal rim thinning – especially in the inferotemporal quadrant.
PURPOSE
To test the hypothesis that specific locations and patterns of threshold findings within the visual field have predictive value for progressive glaucomatous optic neuropathy (pGON).
METHODS
Age-adjusted standard automated perimetry thresholds, along with other clinical variables gathered at the initial examination of 168 individuals with high-risk ocular hypertension or early glaucoma, were used as predictors in a classification tree model. The classification variable was a determination of pGON, based on longitudinally gathered stereo optic nerve head photographs. Only data for the worse eye of each individual were included. Data from 100 normal subjects were used to test the specificity of the models.
RESULTS
Classification tree models suggest that patterns of baseline visual field findings are predictive of pGON with sensitivity 65% and specificity 87% on average. Average specificity when data from normal subjects were run on the models was 69%.
CONCLUSIONS
Classification trees can be used to determine which visual field locations are most predictive of poorer prognosis for pGON. Spatial patterns within the visual field convey useable predictive information, in most cases when thresholds are still well within the classically defined normal range.
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