Can Glaucomatous Visual Field Progression be Predicted by Structural and Functional Measures?

Area of Science:

• Ophthalmology
• Medical Imaging
• Glaucoma Research

Background:

• Early detection of glaucoma is crucial for preventing vision loss.
• Standard automated perimetry (SAP) can be normal in early glaucoma stages.
• Advanced imaging techniques may offer superior predictive capabilities.

Purpose of the Study:

• To compare the predictive value of optical coherence tomography (OCT) and confocal scanning laser ophthalmoscopy (CSLO) for visual field conversion.
• To assess the predictive power of retinal nerve fiber layer thickness (RNFLT) and morphometric parameters in glaucoma progression.
• To evaluate these parameters in normal individuals, ocular hypertensive subjects, and early preperimetric glaucoma patients.

Main Methods:

• Longitudinal study including 107 eyes of controls, 164 eyes of ocular hypertensive patients, and 169 eyes of preperimetric glaucoma patients.
• Baseline examinations included OCT, CSLO, optic disc photography, and frequency-doubling technique perimetry.
• Univariate and multivariate hazard ratios were used to model conversion-free survival.

Main Results:

• Over a median follow-up of 6.9 years, 10.9% of eyes showed visual field conversion.
• RNFLT temporal-inferior measurements by OCT showed a hazard ratio (HR) of 1.2 per 10 μm loss.
• CSLO's Glaucoma probability score demonstrated the highest HR of 1.3 per 0.1 increase in a multivariate model.

Conclusions:

• Both OCT-derived RNFLT and CSLO-derived Glaucoma probability score are highly predictive of future visual field conversion.
• These imaging modalities provide independent predictive information beyond optic disc assessment, central corneal thickness, and SAP pattern standard deviation.
• OCT and CSLO are valuable tools for monitoring glaucoma progression and identifying at-risk individuals.