Association Between Optic Nerve Head Prelaminar Schisis and Visual Field Progression in Glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Research
• Optic Nerve Imaging

Background:

• Glaucoma is a leading cause of irreversible blindness.
• Early detection and monitoring of glaucoma progression are crucial for effective management.
• Optic nerve head (ONH) morphology can provide insights into glaucoma pathogenesis and progression.

Purpose of the Study:

• To investigate the association between baseline optic nerve head prelaminar schisis and the rates of visual field mean deviation (VF MD) slopes in glaucoma.
• To determine if the presence and severity of prelaminar schisis correlate with the speed of visual field loss.

Main Methods:

• Retrospective analysis of 563 eyes from 332 patients with primary open-angle glaucoma or glaucoma suspect.
• Baseline optic nerve head prelaminar schisis presence and severity were graded using optical coherence tomography (OCT) radial scans (0-3 scale).
• Linear mixed-effect models assessed the association between schisis (presence and severity) and VF MD slopes, adjusting for covariates.

Main Results:

• Prelaminar optic nerve head schisis was present in 45.8% of eyes.
• The presence of schisis was significantly associated with faster VF MD slopes (-0.22 dB/y).
• Higher grades of schisis severity (especially grade 3) showed a more pronounced association with accelerated VF progression.

Conclusions:

• The presence and severity of prelaminar schisis are associated with faster visual field progression in glaucoma.
• Prelaminar schisis may serve as a valuable biomarker for identifying glaucoma patients at higher risk of progression.
• This finding can aid in guiding clinical management strategies for glaucoma patients.