
OCT key tool in determining glaucoma progression
Structural evaluation with OCT and functional testing with visual fields should be used throughout the glaucoma disease continuum to detect progression.
This article ws reviewed by Felipe A. Mediros, MD, PhD
Although OCT can detect progression in patients across all stages of disease, the findings from
Therefore, it is essential that patients who have been diagnosed with
Related: Predicting glaucoma progression: More than meets the eye
The above information and recommendations made by Dr. Medeiros are based on findings from analyses of data collected in the Duke Glaucoma Registry Study from over 27,000 eyes of over 14,000 patients with
During follow-up that ranged to almost 9 years, this large patient cohort had undergone more than 100,000 tests with spectral-domain (SD) OCT.
“We believe our undertaking is probably the largest analysis of longitudinal SD OCT and SAP results to date,” Dr. Medeiros said. “Visual field testing remains the primary method of assessing glaucomatous progression. The findings of our study are helpful for understanding where
In analyzing the data, eyes were categorized as having slow, moderate, fast, or catastrophic change over time based on average annual change in SAP or average retinal nerve fiber layer (RNFL) thickness change criteria. For example, eyes with <0.5 dB/year change in SAP or <1 μm/year loss of average RNFL were classified as experiencing slow change.
Dr. Medeiros explained that the cut-off of <1 μm/year was chosen to define slow change based on findings of a study that looked at the impact of normal aging on change in RNFL thickness.
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Data from healthy subjects showed that the 95% confidence interval for age-related loss was up to 1 μm/year.
“Therefore, a slope of RNFL thickness change that is >1 μm/year is likely
The results from analyzing the data in the Duke Glaucoma Registry showed that approximately 30% of eyes experienced moderate or faster glaucomatous progression over time.
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When the subjects were grouped according to
Among subjects who had severe
“We found that most eyes identified as having fast or catastrophic progression by
Related: OCT finds niche in glaucoma diagnosis, management
Clinical correlation
Although changes noted on serial
A case of a patient with vitreous traction illustrates this point. The
Dr. Medeiros also noted that different
Related:
Conclusion
“The Guided Progression Analysis software for a Zeiss OCT platform reports the statistical significance of an event analysis over time, but that feature does not decrease the importance of looking at the scans over time and making sure the quality is adequate,” he concluded.
However, the software users will have to do some work to determine some final data.
“The software for Spectralis (Heidelberg Engineering) does not give the statistical significance of the change, and so users of that device need to determine the clinical significance themselves,” Dr. Medeiros explained.
Felipe A. Medeiros, MD, PhD
E: [email protected]
This article is based on a presentation by Dr. Medeiros at the American Academy of Ophthalmology's Glaucoma Subspecialty Day meeting. Dr. Medeiros is a consultant to and receives research support from Carl Zeiss Meditec and Heidelberg Engineering.
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