IMPORTANCE Macular function is important for daily activities but is underestimated when tested with 24-2 visual fields, which are often used to classify glaucoma severity.OBJECTIVE To test the hypothesis that current glaucoma staging systems underestimate glaucoma severity by not detecting macular damage. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study was carried out in a glaucoma referral practice. The eyes of participants with manifest glaucoma and 24-2 mean deviation (MD) better than −6 dB were included. All participants were tested with 24-2, 10-2 visual fields, and spectral-domain optical coherence tomography of the optic disc and macula.EXPOSURES Macular damage was based on the topographic agreement between visual field results and retinal ganglion cell plus inner plexiform layer probability plots. Classifications from the Hodapp-Parrish-Anderson (HPA), visual field index (VFI), and Brusini staging systems were examined and compared with visual field and spectral-domain optical coherence tomography results. MAIN OUTCOMES AND MEASURESThe association between the presence of macular damage and glaucoma severity scores.RESULTS Fifty-seven eyes of 57 participants were included; 33 participants (57%) were women, and 43 (75%) were white. Their mean (SD) age was 57 ( 14) years. Forty-eight of the eyes (84% [95% CI, 72%-92%]) had macular damage by the study definition. These had a 24-2 MD mean (SD) of −2.5 (1.8); corresponding results for the 10-2 MD were −3.0 (2.4) dB and for the VFI were 94.2% (4.5%). The HPA system classified 70% (95% CI, 55%-83%) of eyes with macular damage as having early defects; the VFI system classified 81% (95% CI, 67%-91%) of eyes with macular damage as having early defects, and the Brusini system 68% (95% CI, 53%-81%).CONCLUSIONS AND RELEVANCE These findings suggest that current glaucoma staging systems based on 24-2 (or 30-2) visual fields underestimate disease severity and the presence of macular damage. If these results are confirmed and generalizable to other participants, new systems using macular measures (from 10-2 and spectral-domain optical coherence tomography results) might improve staging of glaucoma severity.
PurposeTo determine the effectiveness of detecting glaucomatous progression by a qualitative evaluation of wide-field (12 × 9 mm) scans on optical coherence tomography imaging. This method was compared to a conventional quantitative analysis of the global circumpapillary retinal nerve fiber layer (cpRNFL) thickness.MethodsA total of 409 eyes with a clinical diagnosis of glaucoma or suspected glaucoma for which two wide-field scans were obtained at least 1 year apart (n = 125) and within one session (n = 284) were included to determine the sensitivity of detecting progression at 95% specificity. Qualitative OCT evaluation was performed in a similar manner to flicker chronoscopy by superimposing the two scans, and the progression probability was graded. A quantitative event-based analysis of the global cpRNFL thickness also was performed.ResultsThirty-three and 25 eyes were deemed to have progressed based on qualitative and quantitative approaches, respectively (P = 0.152). A post hoc review of cases where the two methods disagreed revealed that all eyes missed by the quantitative analysis had established glaucomatous damage that appeared to show characteristic patterns of progression. All eyes missed by the qualitative evaluation appeared to be free of such established damage, and instead showed a generalized reduction in cpRNFL thickness.ConclusionsQualitative evaluation of OCT imaging information more frequently detected change consistent with known patterns of glaucomatous progression than global cpRNFL thickness, warranting further studies to evaluate its value.Translational RelevanceA framework for qualitatively evaluating progressive glaucomatous changes on OCT imaging clinically shows promise.
PurposeThe purpose of this study was to determine whether a qualitative approach toward evaluating optical coherence tomography (OCT) imaging improves the ability to detect glaucomatous damage compared to a conventional metric of global circumpapillary retinal nerve fiber layer (cpRNFL) thickness.MethodsA total of 394 healthy eyes and 272 glaucoma eyes were evaluated. Glaucoma eyes were categorized as perimetric (156 eyes) based on a history of three or more consecutive abnormal 24-2 visual field tests or suspected glaucoma if they did not (116 eyes). Customized one-page reports derived using OCT volume scans of the optic disc and macula from these eyes were qualitatively graded for the probability of optic neuropathy affecting the eye.ResultsThe sensitivity of detecting perimetric glaucoma eyes with the global circumpapillary RNFL thickness metric and qualitative evaluation of the OCT imaging results were 86.5% and 95.5% at a specificity of 95%, being significantly higher for the latter (P < 0.001). There were seven eyes with perimetric glaucoma missed by the qualitative evaluation. Based upon examination of all available visual fields, at least four of these seven eyes had visual fields that either improved or had abnormalities that were inconsistent over time or with patterns of glaucomatous damage.ConclusionsQualitative evaluation of OCT imaging results allows glaucoma eyes with repeatable visual field abnormalities to be detected with a high level of accuracy, performing better than a conventional summary metric of global cpRNFL thickness.Translational RelevanceClinical detection of glaucomatous damage with OCT imaging can be optimized through a qualitative evaluation of its results.
Purpose: To examine the utility of optical coherence tomography (OCT) for studying eyes with advanced glaucoma [i.e., eyes with a 24-2 visual field (VF) mean deviation (MD) worse than −15 dB], we tested the hypothesis that if these eyes had a 10-2 total deviation (TD) map with points better than −8 dB, then the topographically corresponding regions on the circumpapillary retinal nerve fiber layer (cpRNFL) should show a preserved region. Design: Evaluation of technology studyParticipants: 39 eyes from 33 patients (mean: 68.8 ± 9.2 years) with a diagnosis of glaucoma had a 24-2 VF with a MD ≤ −15 dB (mean: −18.94 ± 2.95 dB). All eyes additionally had a 10-2 VF and an averaged OCT circle scan. Methods: Each scan was inspected, and preserved cpRNFL regions of the disc associated with the macula (central ±8° were delin eated. Main Outcome Measures:The number of eyes with preserved cpRNFL regions and their association with preserved VF locations (i.e. better than −8 dB) shown in the 10-2 VF TD map.Results: 38 of the 39 eyes had one or more points on the 10-2 VF with TD values that were better than −8 dB (mean: 25.7 ± 12.6 points). For all 39 eyes, there was a preserved portion of the cpRNFL on the circle scan within the disc region associated with the macula. However, for 3 of these eyes, this region was hypodense and could be a challenge for the clinician to identify.
PurposeOur purpose was to compare the effectiveness of detecting progressive retinal nerve fiber layer (RNFL) thickness changes using widefield scans compared to circumpapillary circle scans derived from optic disc volume scans when using a manual region-of-interest (ROI) approach.MethodsIn a prospective observational study, a total of 125 eyes diagnosed clinically with glaucoma or suspected glaucoma that had both widefield (12 × 9 mm) and optic disc (6 × 6 mm) scans obtained at least one year apart were included. Changes in the RNFL thickness between the two visits were evaluated within region(s) of observed or suspected glaucomatous damage, which were manually outlined after reviewing key features from each scan on the second visit (described as a manual ROI approach). Within ROI(s), changes in the widefield and circumpapillary RNFL thickness (wfRNFLROI and cpRNFLROI), as well as in the global circumpapillary RNFL thickness (cpRNFLG), were determined. The performance of these three methods for detecting progressive changes was compared using longitudinal signal-to-noise ratios (SNRs), whereby the rate of change determined by each method was normalized by individualized estimates of measurement variability and age-related change.ResultsOn average, the longitudinal SNRs for the wfRNFLROI, cpRNFLROI, and cpRNFLG methods were −0.57, −0.38, and −0.23 y−1, respectively, being significantly more negative for the wfRNFLROI than the latter two methods (P ≤ 0.009).ConclusionsProgressive RNFL thickness changes were more effectively detected on widefield optical coherence tomography (OCT) scans using a manual ROI approach compared to conventional derived circumpapillary circle scans.Translational RelevanceWidefield OCT scans show promise for improving the detection of glaucomatous progression.
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