Comparing Rates of Change in Moderate to Advanced Glaucoma: Retinal Nerve Fiber Layer Versus Bruch Membrane...

Area of Science:

• Ophthalmology
• Glaucoma Research
• Medical Imaging

Background:

• Glaucoma is a progressive optic neuropathy often characterized by structural damage.
• Accurate monitoring of structural changes is crucial for managing glaucoma.
• Peripapillary retinal nerve fiber layer (RNFL) thickness and Bruch membrane opening-based minimum rim width (BMO-MRW) are key metrics for assessing optic nerve health.

Purpose of the Study:

• To compare the rates of change (RoC) for RNFL thickness and BMO-MRW in patients with moderate-to-advanced glaucoma.
• To evaluate which measurement provides a better longitudinal signal-to-noise ratio (LSNR) for detecting structural progression.

Main Methods:

• A prospective cohort study involving 113 eyes of glaucoma patients with moderate-to-advanced or central damage.
• Longitudinal optical coherence tomography (OCT) scans were analyzed to estimate global and sectoral RoC for RNFL and BMO-MRW using linear mixed effects models and simple linear regression (SLR).
• Permutation analyses and LSNR (RoC/residual SD) were used to compare the sensitivity of RNFL and BMO-MRW measurements.

Main Results:

• RNFL thickness showed a higher proportion of significant negative RoC compared to BMO-MRW in the inferotemporal and inferonasal sectors.
• Permutation analyses indicated a greater proportion of worsening RNFL RoC than BMO-MRW.
• Longitudinal signal-to-noise ratios for RNFL were significantly more negative than for BMO-MRW globally and in multiple sectors.

Conclusions:

• Longitudinal RNFL OCT measurements are more sensitive in detecting structural changes in glaucoma patients with moderate-to-advanced or central damage.
• RNFL OCT demonstrates superior LSNR compared to BMO-MRW for monitoring glaucoma progression.