Impact of Rates of Change of Lamina Cribrosa and Optic Nerve Head Surface Depths on Visual Field Progression in Glaucoma

Abstract

Citation: Wu Z, Lin C, Crowther M, Mak H, Yu M, Leung CK-S. Impact of rates of change of lamina cribrosa and optic nerve head surface depths on visual field progression in glaucoma. Invest Ophthalmol Vis Sci. 2017;58:182558: -183358: . DOI:10.1167 PURPOSE. To investigate the impact of the rates of change of anterior lamina cribrosa surface depth (ALCSD) and optic nerve head surface depth (ONHSD) on visual field (VF) progression in glaucoma. METHODS.One hundred forty-six eyes of 95 glaucoma patients had optical coherence tomography ONH imaging and VF testing at approximately 4-month intervals for greater than or equal to 5 years. Anterior lamina cribrosa surface depth and ONHSD were measured with reference to (1) Bruch's membrane opening (BMO), and (2) choroid-sclera interface (CSI). The rates of change of ALCSD and ONHSD of individual eyes were measured with linear regression analysis. The hazard ratios (HRs) of the rates of change of ALCSD/ONHSD for prediction of VF progression as per Early Manifest Glaucoma Trial criteria were determined by joint longitudinal and survival models.RESULTS. Using the BMO reference, 23.3% and 28.1% of eyes showed a significant positive trend (posterior displacement), whereas 29.5% and 24.0% showed a significant negative trend (anterior displacement) of ALCSD and ONHSD, respectively. Using the CSI reference, the proportions with a significant negative trend decreased to 11.6% and 14.4%, respectively; and the proportions with a significant positive trend increased to 37.7% and 38.4%, respectively. The HRs of VF progression were 1.06 and 1.11 for each micrometer per year increase in the rates of change of ALCSD BMO and ONHSD BMO , respectively; and 1.07 and 1.09 for each micrometer per year increase in the rates of change of ALCSD CSI and ONHSD CSI , respectively. CONCLUSIONS.Identifying fast progressors of posterior ALCS/ONHS displacement is relevant to the management of glaucoma patients as they have a higher risk of VF progression.Keywords: optic nerve head surface depth, anterior lamina cribrosa surface depth, optical coherence tomography O ptic nerve head (ONH) deformation is a defining feature of glaucoma. While confocal scanning laser ophthalmoscopy (CSLO) and optical coherence tomography (OCT) have been widely adopted for measurement of the neuroretinal rim, [1][2][3][4][5][6] parameters like anterior lamina cribrosa surface depth (ALCSD) and ONH surface depth (ONHSD) are rarely examined in clinical practice. Studies reporting long-term, progressive LC and ONH surface deformation in glaucoma patients are sparse. We previously investigated the longitudinal changes of ALCSD and ONHSD in glaucoma patients with reference to Bruch's membrane opening (BMO) using an event analysis. 7 However, event analysis cannot reveal how fast an individual eye is progressing. The rates of change of ALCSD and ONHSD over the course of glaucoma progression have not been reported. The significance of measurement of LC and ONH deformation in the management of glaucoma patients remains unclear.Studie...

Pulling and Tugging on the Retina: Mechanical Impact of Glaucoma Beyond the Optic Nerve Head

“…[42][43][44][45][46] [Note: the anterior LC surface depth, ALCSD, is typically measured relative to a reference plane such as the Bruch's membrane (BM), its termination (BM opening [BMO]), or the choroidalscleral interface, CSI. [47][48][49][50] ] These LC differences measured by OCT are most apparent in glaucomatous eyes with a history of higher intraocular pressure (IOP) and for patients of relatively younger age. 45,46,48,[51][52][53] Recent evidence shows that greater LC depth and curvature are also predictive of faster glaucoma progression.…”

“…[47][48][49][50] ] These LC differences measured by OCT are most apparent in glaucomatous eyes with a history of higher intraocular pressure (IOP) and for patients of relatively younger age. 45,46,48,[51][52][53] Recent evidence shows that greater LC depth and curvature are also predictive of faster glaucoma progression. 54 In addition, OCT studies have confirmed and extended evidence that these LC structural differences are unique to glaucoma among optic neuropathies, particularly when matched for otherwise similar levels of VF damage and nerve fiber layer loss.…”

Joint longitudinal and time-to-event models for multilevel hierarchical data

“…For example, in glaucoma research we may be interested in the association between optic nerve head surface depth (ONHSD) and visual field progression. Previous studies [12] have used joint models to explore this association by treating each eye as independent and modelling the association between the eye-specific longitudinal trajectory for ONHSD and the eye-specific event endpoint (visual field progression). However, this approach ignores the dependence between measurements taken on the two eyes clustered within a patient.…”

Imaging of the lamina cribrosa and its role in glaucoma: a review

“…89 When the IOP in glaucomatous eyes was lowered after the introduction of medical therapy, 90 or after glaucoma filtration surgery, 91,92 a mean reduction in the anterior LCD was noted. In prospective studies of glaucoma patients, greater LCD was also associated with greater visual field progression 93 and faster rates of retinal nerve fibre layer (RNFL) thinning. 94 However, results with LCD have not always been consistent.…”