Abstract
We thank Dr Hwang for his insightful comments regarding our study.1Lavinsky F. Wu M. Schuman J.S. et al.Can macula and optic nerve head parameters detect glaucoma progression in eyes with advanced circumpapillary retinal nerve fiber layer damage?.Ophthalmology. 2018; 125: 1907-1912Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar In our study, we demonstrated with OCT that eyes with advanced structural glaucomatous damage still had significant progression of macular ganglion-cell inner plexiform layer and optic nerve head parameters after reaching the minimal measurable circumpapillary retinal nerve fiber layer thickness (floor effect).1Lavinsky F. Wu M. Schuman J.S. et al.Can macula and optic nerve head parameters detect glaucoma progression in eyes with advanced circumpapillary retinal nerve fiber layer damage?.Ophthalmology. 2018; 125: 1907-1912Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar Using guided progression analysis (GPA), the commercially available progression detection tool, we also demonstrated that more eyes were labeled as progressing by the trend-based analysis with optic nerve head parameters and ganglion-cell inner plexiform layer compared with retinal nerve fiber layer thickness measurements. Our results are in agreement with a previous study that showed this progression pattern in the GPA trend analysis also occurs at earlier stages of the disease.2Hwang Y.H. Kim Y. Chung J.K. et al.Glaucomatous progression in the retinal nerve fibre and retinal ganglion cell-inner plexiform layers determined using optical coherence tomography-guided progression analysis.Clin Exp Optom. 2018; 101: 666-673Crossref PubMed Scopus (9) Google Scholar Although this pattern of trend analysis progression might not be unique to advanced disease, detection of progression is particularly difficult in advance disease, as we discussed in our article. Therefore, having the capability of detecting progression at this stage has important clinical implications worth emphasizing to practicing clinicians. The discrepancy referred to by Dr Hwang concerning the event-analysis GPA progression rate between our study and a study conducted by Shin et al3Shin J.W. Sung K.R. Lee G.C. et al.Ganglion cell-Inner plexiform layer change detected by optical coherence tomography indicates progression in advanced glaucoma.Ophthalmology. 2017; 124: 1466-1474Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar is related to the difference in GPA outcome categorization. Whereas Dr Shin’s study defined progression as eyes labeled as likely progression only, we took a more sensitive approach and considered both possible and likely labeled eyes as progressing. The interpretation of this finding is discussed in our article.1Lavinsky F. Wu M. Schuman J.S. et al.Can macula and optic nerve head parameters detect glaucoma progression in eyes with advanced circumpapillary retinal nerve fiber layer damage?.Ophthalmology. 2018; 125: 1907-1912Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar Unfortunately, we cannot address the discrepancy with Dr Hwang’s unpublished data on the optic nerve head analysis without having the ability to evaluate these results. Nevertheless, we are in full agreement with Dr Hwang’s conclusion that further studies are required to optimize clinical evaluation in advanced glaucoma. Re: Lavinsky et al.: Can macula and optic nerve head parameters detect glaucoma progression in eyes with advanced circumpapillary retinal nerve fiber layer damage? (Ophthalmology. 2018;125:1907-1912)OphthalmologyVol. 126Issue 2PreviewI read the article by Lavinsky et al1 with great interest. In that study, serial OCT data from 44 eyes with advanced glaucoma were assessed and rates of changes in circumpapillary retinal nerve fiber layer (RNFL) thickness, optic nerve head (ONH) parameters, and macular ganglion cell-inner plexiform layer (GCIPL) thickness were analyzed. The study results revealed that no significant rate of change was noted for RNFL thickness, whereas significant rates of change were detected for GCIPL thickness and ONH parameters. Full-Text PDF
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