Predicting Perimetric Glaucoma Development in Suspects Using Widefield OCT-Based Risk Scores

To evaluate the predictive ability of baseline widefield OCT-based risk scores for the development of perimetric glaucoma in glaucoma suspect eyes.

A prospective cohort study.

Two hundred fifty-seven glaucoma suspect eyes with normal visual fields (VFs) at baseline from 180 patients.

Baseline macular and peripapillary inner retinal layer thickness measurements were obtained using swept-source OCT widefield scans (12 mm × 9 mm) that included both the optic disc and macula. Three OCT-based risk scores were calculated for each eye using measurement segments and grids from the OCT reports. Glaucoma progression was defined as the development of repeatable abnormal VF results. Marginal Cox proportional hazards model was applied to evaluate baseline predictors, including risk scores and individual OCT thickness metrics, with adjustment for confounding factors.

Time-dependent receiver operating characteristic (ROC) curves and decision curve analysis evaluated model performance and clinical utility.

The mean follow-up time for glaucoma suspects was 2.8 years. During this period, 80 suspect eyes progressed to perimetric glaucoma. Circumpapillary retinal nerve fiber layer (RNFL) thickness, ganglion cell complex thickness, ganglion cell-inner plexiform layer thickness, mean deviation, and the 3 OCT-based risk scores were predictors of progression in univariable models, showing significant hazard ratios, whereas only the OCT-based risk scores remained statistically significant in multivariable models. Each 10-point increase in OCT-based risk scores across the 3 models corresponded to a 1.15-fold to 1.21-fold increase in risk. The risk scores demonstrated higher area under ROCs, compared to individual OCT parameters, across all time points. Decision curve analysis showed that individual OCT parameters offered no greater net benefit than treating all patients regardless of risk, whereas the Fukai risk scores consistently yielded higher net benefit.

Baseline OCT-based risk scores from a single wide scan, incorporating both peripapillary RNFL and macular thickness measurements, are associated with the subsequent development of perimetric glaucoma development in glaucoma suspect eyes, offering valuable insights for risk stratification in a single integrated metric and may aid in early intervention and clinical management in glaucoma suspects.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.