Abstract
Background: to investigate the rate of change (ROC) of Bruch’s membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness in early normal tension glaucoma (NTG) patients. Methods: in this longitudinal cohort study, 115 subjects (115 eyes) diagnosed as early NTG (mean deviation > −6.0 dB) and who had completed more than five times of spectral-domain optical coherence tomography (OCT) tests with acceptable quality were included. Measurement of BMO-MRW and RNFL were performed at 3-month intervals by OCT. Linear mixed-effects model was employed to calculate the ROC in global region and six Garway-Heath sectors with adjusting age, sex, and BMO area. Results: Average follow-up was 20.99 ± 6.99 months with OCT number of 7.54 ± 2.12. Baseline intraocular pressure was 14.72 ± 2.70 mmHg and MD was −2.73 ± 2.26 dB. ROC of global BMO-MRW was −2.06 ± 0.65 µm/yr and RNFL was −0.96 ± 0.16 µm/yr (p = 0.098). The most rapid ROC was in inferotemporal sector (BMO-MRW: −3.02 ± 0.88 µm/yr, RNFL: −1.96 ± 0.36 µm/yr) followed by superotemporal sector. Conclusion: The ROC of BMO-MRW, the new parameter along with that of RNFL should be considered in the management of early NTG. BMO-MRW may show visible reduction ROC better than RNFL to detect early progression in early NTG when visual field may not show significant change.
Highlights
Glaucoma is a progressive optic neuropathy accompanied by a deficit of the retinal nerve fiber layer (RNFL) with a corresponding thinning of neuroretinal rim (NRR) tissue that can lead to progressive visual field defect [1,2]
Considering that a change of structural parameter is more important in early normal tension glaucoma (NTG) than in advanced stage, investigating the rate of change (ROC) of optical coherence tomography (OCT)-based parameters, for instance, RNFL and Bruch’s membrane opening-minimum rim width (BMO-MRW), would have significant meaning
Structural parameters acquired by OCT might be more advantageous in detecting early progressive changes than a standard visual field test
Summary
Glaucoma is a progressive optic neuropathy accompanied by a deficit of the retinal nerve fiber layer (RNFL) with a corresponding thinning of neuroretinal rim (NRR) tissue that can lead to progressive visual field defect [1,2]. Considering that a change of structural parameter is more important in early NTG than in advanced stage, investigating the rate of change (ROC) of OCT-based parameters, for instance, RNFL and BMO-MRW, would have significant meaning. Considering the relatively small ROC of RNFL, which is less than −1.0 μm/yr in Asian cohorts with NTG predominance, early detection of glaucomatous deterioration with subtle change of RNFL in clinical situation may be difficult. The aim of this longitudinal cohort study was to investigate ROCs of BMO-MRW and RNFL in patients with early NTG.
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