Structural and Functional Progression in the Early Manifest Glaucoma Trial

Area of Science:

• Ophthalmology
• Glaucoma Research
• Visual Neuroscience

Background:

• Glaucoma is a leading cause of irreversible blindness.
• Early detection of glaucoma progression is crucial for timely intervention.
• Assessing optic disc and visual field changes are key diagnostic methods.

Purpose of the Study:

• To determine the temporal sequence of optic disc and visual field progression in glaucoma.
• To compare the timing of progression detection between fundus photography and visual field testing.

Main Methods:

• A prospective, randomized, longitudinal trial (Early Manifest Glaucoma Trial - EMGT) followed 306 study eyes with glaucoma and 192 fellow eyes.
• Optic disc progression was assessed by three independent graders using fundus photographs over 8 years.
• Visual field progression was evaluated using glaucoma change probability maps and the EMGT criterion.

Main Results:

• In eyes with manifest glaucoma, visual field progression was detected first in 52% of cases, while optic disc progression was detected first in only 12%.
• In fellow eyes without baseline field defects, optic disc progression was detected first in 18% and visual field progression in 15%.

Conclusions:

• Visual field progression is detected significantly earlier than optic disc progression in eyes with manifest glaucoma.
• In eyes without initial visual field loss, optic disc progression detection frequency is similar to visual field progression detection.