Structural and Functional Progression in the Early Manifest Glaucoma Trial

Abstract

Objective To elucidate the temporal relationship between detection of glaucomatous optic disc progression, as assessed by fundus photography, and visual field progression. Design Prospective, randomized, longitudinal trial. Subjects Three hundred and six study eyes with manifest glaucoma with field loss and 192 fellow eyes without any field defect at the start of the trial, of a total of 249 subjects included in the Early Manifest Glaucoma Trial (EMGT) were assessed. Methods Evaluation of visual field progression and optic disc progression during an 8-year follow-up period. Three graders independently assessed optic disc progression in optic disc photographs. Visual field progression was assessed using glaucoma change probability maps and the EMGT progression criterion. Main outcome measures Time to detection of visual field progression and optic disc progression. Results Among study eyes with manifest glaucoma, progression was detected in the visual field first in 163 eyes (52%), in the optic disc first in 39 eyes (12%) and in 1 eye (0%) it was found simultaneously with both modalities. Among fellow eyes with normal fields, progression was detected in the visual field first in 28 eyes (15%), in the optic disc first in 34 eyes (18%) and in 1 eye (1%) it occurred simultaneously. Conclusion In eyes with manifest glaucoma, progression in the visual field was detected first more than four times as often as progression in the optic disc. Among fellow eyes without visual field loss at baseline, progression was detected first as frequently in the optic disc as in the visual field.

Detection of glaucoma progression by perimetry and optic disc photography at different stages of the disease: results from the Early Manifest Glaucoma Trial

“…Still, comparing with our earlier published results showing an equal ability to detect progression with monoscopic optic disc photographs and automated perimetry in eyes with preperimetric glaucoma (Öhnell et al. ), it is somewhat surprising that we could not detect a higher proportion of optic disc progressions during earlier stages of manifest glaucoma, with a gradual increase of perimetric progression through more advanced stages of the disease.…”

“…The disc reading procedure is described in detail elsewhere (Öhnell et al. ). Briefly, the readers were masked to the temporal order of the photographs and all other patient data.…”

“…Our group (Öhnell et al. ) has published a random sample of a dozen optic discs deemed to have progressed to illustrate the magnitude of changes required to classify a disc as progressing.…”

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

“…6,12,34,38,47 Recent studies have focused on the comparison between progression identified with NFL or optic disc OCT imaging and visual fields. 12,38,48 Abe et al suggested that in patients with different glaucoma stages, monitoring NFL with spectral-domain OCT gives a higher chance of detection of disease progression in early stages, while VF testing is more relevant in later stages 38 .…”

Detecting Change Using Standard Global Perimetric Indices in Glaucoma

“…1, 2 While the rate of retinal nerve fiber layer thinning does correlate with the rate of functional change, 3 the ability to detect glaucomatous progression using structural measurements alone has been reported to be limited. 4–6 Since function is an important outcome measure for the patient because it relates to quality of life and activities of daily living, perimetry will remain a necessary clinical management tool for the foreseeable future. 7 Most commonly, this is performed using white-on-white standard automated perimetry (SAP).…”