Glaucoma Progression Analysis Research Articles

Comparison of Visual Field Fluctuation Between Myopic and Emmetropic Glaucoma Patients

Background: Conflicting epidemiologic studies suggest that myopia may both increase and decrease the risk of glaucomatous visual field loss. To provide appropriate treatment to glaucoma patients, it is important to detect meaningful changes in the visual field, which requires distinguishing between visual field fluctuation and progression. Visual field fluctuation is defined as the variability between two visual field tests performed on separate days or months on the same eye that cannot be attributed to a pathologic change. We hypothesize that glaucoma patients with myopia will demonstrate more visual field fluctuation compared to emmetropic patients.
 Methods: Four or more 24-2 or 30-2 Humphrey visual field tests over several visits will be analyzed per patient. Data including the VFI plot, mean deviation, and threshold sensitivity on the glaucoma progression analysis will be collected to measure fluctuation. The sample is divided into two groups: 1. emmetropic glaucoma patients with a spherical equivalent refraction between +2 to -2 diopters and 2. high myopic glaucoma patients with a spherical equivalent refraction over -5 diopters. Bland-Altman plots, Mann-Whitney U tests, Root Mean Square Error (RMSE), intraclass correlation coefficients, and generalized estimating equation models for ordinal data will be used to analyze the collected data.
 Results: Thus far, 2,979 charts have been reviewed with data collected from 27 emmetropes and myopes who met the inclusion criteria. The recruitment goal is 78 per group and 156 total. Preliminary results for RMSE found a statistically significant p-value for mean deviation (0.0320), and no statistically significant difference for threshold sensitivity (0.5179) and VFI (0.0904).
 Conclusion and Potential Impact: This ongoing study will help establish if glaucoma patients with high myopia demonstrate greater visual field fluctuation. It is important for clinicians to have this information so that these patients can be examined carefully to prevent misdiagnoses or delayed glaucoma treatment.

Survey on electronic visual field data transfer practices among Japan Glaucoma Society board members

BackgroundVisual field (VF) testing in combination with a specialized VF analysis software is critical for characterizing and monitoring visual loss in glaucoma. Although performing glaucoma progression analysis requires original VF data rather than printouts or image files, extent of VF data transfer between referring and referred ophthalmologists is unclear. Here, we surveyed glaucoma specialists who belong to the Japan Glaucoma Society (JGS).MethodsAn internet survey of daily practice patterns regarding electronic VF data transfer at the time of glaucoma referrals (referring/referred) was sent to all 50 JGS board members. The survey consisted with 11 questionnaires, and the response rate was 100%.ResultsThe respondents included 33 university hospital ophthalmologists (66%) (Q1), and those scattered throughout Japan (Q2). All respondents used Humphrey Visual Filed Analyzer (HFA) (Q3) and at least one of a VF progression analysis software (Q4). Ten respondents (20%) actively transferred electronic VF data, while 40 (80%) did not (Q5). The major reasons for not actively transferring data electronically were that there was no support for data transfer by neighboring (n = 26, 65%) and/or own (25, 63%) institutes (Q6). All 40 inactive respondents responded that electronic data transfer is ideal (Q7). All 10 active respondents transferred data using USB flash memory (Q8). Of the 10 active respondents, seven (70%) reported that the percentage of referral letters accompanying electronic VF data in a format that allows for progression analysis from the beginning was less than 25% (Q9). When the referral letters did not accompany the electronic VF data, four (40%) reported that they further requested the data transfer in < 25% of cases (Q10). When the 10 active respondents were requested to transfer data, six (60%) had experienced rejection due to various reasons (Q11).ConclusionAn internet survey showed that 80% of the JGS board members were not actively transferring VF data mainly because of the absence of a system in place at institutions for sending and receiving data, although they feel that the electronic VF data transfer is ideal. The results provide basic data for future discussions on the promotion of the VF data transfer.

Longitudinal evaluation of RTVue optical coherence tomography in patients with glaucoma and suspected glaucoma and stable visual fields.

To longitudinally compare isolated structural parameters obtained using RTVue optical coherence tomography in patients with glaucoma and suspected glaucoma with stable visual fields. All patients were required to have a reliable SITA Standard 24-2 Humphrey Visual Field test. Visual field stability was defined as having <5 points with p<5% and/or having no points with p<1% and/or p<0.05% in the glaucoma progression analysis comparison graph. Furthermore, the glaucoma assessment strategy was used in optical coherence tomography. The study included 75 eyes from 75 patients, 43 of which had glaucoma and 32 had suspected glaucoma. The mean visual field intervals were 29.57 ± 9.65 months between the first and third tests. No visual field parameter variations (mean deviation, pattern standard deviation, and visual field index) and no retinal nerve fiber layer or optic disk parameter variations between the first and third tests were observed (p>0.05 for all), and no retinal nerve fiber layer parameter variations throughout the study were observed, except for optic disk parameters presenting with cup volume changes (p=0.004). However, ganglion complex cells presented a progressively decreased average ganglion cell complex parameter, with a variability of -0.98% ± 3.71% (p=0.04) between the first and third tests. By contrast, the global loss volume progressively increased throughout the study, with a variability of 14.71% ± 44.52% (p=0.04) between the first and third tests. The inferior ganglion cell complex parameter was significantly decreased between the first and third tests (p=0.02). The present findings suggest that patients with glaucoma or suspected glaucoma with stable visual fields may present structural ganglion complex cell progression as assessed using RTVue optical coherence tomography.

Single nucleotide polymorphisms in LOXL1 as biomarkers for progression of exfoliation glaucoma in Sweden.

Exfoliation glaucoma is a common and aggressive type of glaucoma with high prevalence in Scandinavia. The aim of this study was to elucidate whether the allele frequencies of two single nucleotide polymorphisms (SNPs) located in LOXL1 were associated with the progression of exfoliation glaucoma in Swedish patients. In this non-randomised cohort study, we enrolled patients with exfoliation glaucoma, and they performed at least five reliable visual field tests. Blood samples were collected, and genotyping was performed using competitive allele-specific PCR genotyping. Glaucoma progression was evaluated using the guided glaucoma progression analysis (GPA), mean deviation (MD) difference and rate of progression (ROP). In addition, associations between allele frequencies and glaucoma progression were tested using logistic regression for GPA and linear regression for MD and ROP. We enrolled a total of 130 patients in the study. The general genetic model showed statistical significance for LOXL1_rs2165241 (p=8 × 10-7 , Fisher's exact test) and LOXL1_rs1048661 (p=2 × 10-6 , Fisher's exact test). Regression analyses using an additive genetic model showed significant values for LOXL1_rs2165241SNP in relation to GPA, MD and ROP as outcomes (p=1.8 × 10-4 , 4 × 10-2 , 6 × 10-4 ) and for LOXL1_rs1048661 SNP in relation to GPA, MD and ROP (p=7 × 10-5 , 8 × 10-3 , 2 × 10-4 ). This was the first study to show an association of the SNPs LOXL1_rs2165241 and LOXL1_rs1048661 with the progression of exfoliation glaucoma. Further large-scale studies are required to verify these findings.

Trigger happy" visual field: Ten pointers.

While performing the visual field test, some patients press the response button, at random and not in response to seeing a stimulus, resulting in a classical trigger happy visual field. This can be identified by 10 pointers as shown in this single field analysis printout of Humphrey visual field (HVF), 24-2, Swedish interactive threshold algorithm (SITA) standard test of the right eye. These points are useful teaching points for the students to recognize. The video describes classical 10 points, which can be identified in an HVF 24-2 printout in a patient with high false-positive (FP) error. The FP index is the most useful of the reliability indices. In SITA strategy, the FP rate is based upon the assessment of patient's reaction time over the entire course of the test, and hence is not calculated until the test is completed. Therefore, it is important for the perimetrist to be alert to recognize the signs early during the test, such as high fixation los s (despite good fixation as seen on screen monitor) and unusually high retinal sensitivity values (up to 50 dB), and reinstruct the patient. If the test is completed, it should be repeated. This is important as the FP rates >15% are associated with compromised test results and are automatically removed from the glaucoma progression analysis. https://youtu.be/UMVw2vkzdfQ.

Predicting Visual Field Progression by Optical Coherence Tomography Angiography and Pattern Electroretinography in Glaucoma.

Reduced P50-N95 amplitude on pattern electroretinography (PERG) and the presence of microvasculature dropout (MvD) on optical coherence tomography angiography (OCT-A) at baseline were significant factors associated with visual field (VF) progression in predominantly normal tension glaucoma (NTG) patients. We investigated the baseline demographics and ocular characteristics that predict future progression in glaucoma patients, including PERG and OCT-A parameters. One Hundred forty eyes with open angle glaucoma that were prospectively enrolled and followed up for at least 3 years, and underwent at least 5 serial VF tests were included. Baseline PERG was performed, and N35, P50, and N95 latencies and amplitudes were obtained. Superficial vessel density at the macula and complete loss of microvasculature within the deep retinal layer of the parapapillary region (MvD) were evaluated from baseline OCT-A images. Eyes with a glaucomatous VF defect in either both hemifields within 24 points of a central 10 degrees of fixation, and with no VF abnormality in the nasal periphery outside 10 degrees of fixation, were considered to have isolated central scotoma. During follow-up, detected disc hemorrhage (DH) was recorded. Parameters associated with VF progression were determined using linear regression analysis of the mean deviation (MD) values, in combination with an event-based analysis using the Glaucoma Progression Analysis (GPA) software from the Humphrey Field Analyzer. "Likely progression" using GPA was considered to have glaucoma progression. Of the 140 eyes, 107 (76.4%) were NTG and 57 (40.7%) exhibited glaucoma progression as defined by Humphrey VF GPA. The MD slopes were -0.43±1.11dB/y in the progressors and 0.59±1.27dB/y in the nonprogressors ( P <0.001). Glaucoma patients with progression showed frequent MvD on OCT-A, isolated central scotoma, frequent DH, and reduced baseline P50-N95 amplitude compared with patients without progression. Age at diagnosis ( P =0.038) and baseline P50-N95 amplitude ( P =0.019) showed significant associations with the MD slope. The presence of MvD on OCT-A ( P <0.001) and baseline P50-N95 amplitude ( P =0.037) were significantly associated with VF progression on GPA. The presence of MvD and retinal ganglion cell dysfunction by PERG at baseline, DH or central scotoma were significant factors associated with VF progression in predominantly NTG patients. These patients should be monitored more closely.

Change of peripapillary retinal nerve fiber layer and choroidal thickness during 4-year myopic progress: Boramae Myopia Cohort Study Report 4

AimsTo investigate the longitudinal changes of peripapillary retinal nerve fibre layer (RNFL) and choroidal thickness during myopic axial elongation.MethodsPeripapillary RNFL and choroidal thickness were prospectively evaluated by spectral-domain optical coherence...

Light‐field imaging for glaucoma diagnosis—reproducibility on one patient

PurposeA suspicious optic nerve head appearance with abnormal cupping or increased cup‐to‐disc ratio is considered as a strong risk factor for glaucoma. Typical systems to measure this deformation are optical coherence tomography or scanning laser ophthalmoscopy. We show that the needed depth information for glaucoma diagnosis can be obtained reliably with a commercial fundus camera using an adapted light‐field camera providing a one‐shot 3d retinal image.MethodsWe examined the left eye of a glaucoma suspect (male, 39 years) 11 times in compliance with the Declaration of Helsinki. For each examination, the glaucoma suspect repositioned himself and the device was readjusted. The images were taken with a fundus camera (FF450, Carl Zeiss Meditec AG) combined with a modified light‐field camera (Raytrix R12, Raytrix GmbH). The eye was illuminated with a wavelength of 520 nm (±20 nm). The absolute virtual depth (VD) values were exported from the Raytrix software (RxLive 5.0, Raytrix GmbH) and further processed in Matlab R2018. All data were aligned to each other to measure at similar locations. The maximum VD on a vessel segment above the rim and the minimum above the root of the vessel inside the optic nerve head was determined to calculate the depth difference.ResultsAll images showed a clearly identifiable optic nerve head structure and allowed a successful and reliable determination of the depth information. The average relative depth difference over all examinations was 6.1 ± 0.34VD. The 95% confidence interval was between 5.86 and 6.34VD. Besides the depth values also the lateral values are virtual because of an aperture mismatch between fundus camera and light‐field camera. A successful depth estimations of the Raytrix software require high contrast images with textures. Caused by the objective of the fundus camera image distortions existed.ConclusionsThe presented results from our preliminary system show the potential of the light‐field technique to be used for glaucoma diagnostics and progression analysis based on the optic nerve head in 3D. Reliable and reproducible measurements of this technique can enhance the informative value of the classical fundus photography.

Artificial Intelligence Algorithms to Diagnose Glaucoma and Detect Glaucoma Progression: Translation to Clinical Practice.

PurposeThis concise review aims to explore the potential for the clinical implementation of artificial intelligence (AI) strategies for detecting glaucoma and monitoring glaucoma progression.MethodsNonsystematic literature review using the search combinations “Artificial Intelligence,” “Deep Learning,” “Machine Learning,” “Neural Networks,” “Bayesian Networks,” “Glaucoma Diagnosis,” and “Glaucoma Progression.” Information on sensitivity and specificity regarding glaucoma diagnosis and progression analysis as well as methodological details were extracted.ResultsNumerous AI strategies provide promising levels of specificity and sensitivity for structural (e.g. optical coherence tomography [OCT] imaging, fundus photography) and functional (visual field [VF] testing) test modalities used for the detection of glaucoma. Area under receiver operating curve (AROC) values of > 0.90 were achieved with every modality. Combining structural and functional inputs has been shown to even more improve the diagnostic ability. Regarding glaucoma progression, AI strategies can detect progression earlier than conventional methods or potentially from one single VF test.ConclusionsAI algorithms applied to fundus photographs for screening purposes may provide good results using a simple and widely accessible test. However, for patients who are likely to have glaucoma more sophisticated methods should be used including data from OCT and perimetry. Outputs may serve as an adjunct to assist clinical decision making, whereas also enhancing the efficiency, productivity, and quality of the delivery of glaucoma care. Patients with diagnosed glaucoma may benefit from future algorithms to evaluate their risk of progression. Challenges are yet to be overcome, including the external validity of AI strategies, a move from a “black box” toward “explainable AI,” and likely regulatory hurdles. However, it is clear that AI can enhance the role of specialist clinicians and will inevitably shape the future of the delivery of glaucoma care to the next generation.Translational RelevanceThe promising levels of diagnostic accuracy reported by AI strategies across the modalities used in clinical practice for glaucoma detection can pave the way for the development of reliable models appropriate for their translation into clinical practice. Future incorporation of AI into healthcare models may help address the current limitations of access and timely management of patients with glaucoma across the world.

Less Evening Exercise is Associated with Progressive Visual Field Defect in POAG Patients

PURPOSE: To investigate the exercise habits of those with primary open angle glaucoma (POAG) and its associations with the progression of glaucomatous visual field (VF) loss. METHODS: Daily PA was monitored by an accelerometer (ActiGraph wGT3x-BT), which patients wore for 24-hours on their waist (right) for 1 week. main outcome measures are daily PA, such as calories (kcal), light PA time, moderate PA time, vigorous PA time, moderate to vigorous physical activity (MVPA) and step counts.Progressive VF loss is defined as the same three or more points in pattern deviation change probability maps in at least two consecutive visits detected by Glaucoma Progression Analysis. RESULTS: No significant difference was found for daily PA between the 76 non-progressive and 22 progressive patients who wore the device for more than 10 hours per day (P>0.05 for all). Better eye VF mean deviation (MD) averaged -3.1 dB in non-progressive group and -4.1dB in progressive group. 88 (89.8%) participants who had worn an accelerometer for an entire day were analyzed for their 24-hour exercise habits. Patients with POAG preferred to exercise more during 07:00-09:00 am, 15:00-17:00 pm, and 18:00-20:00 pm. Additionally, MVPA time in the non-progressive group is significantly higher than the progressive group at 18:00-20:00 pm (25.0(34.3) min VS 18.9(17.6) min, P=0.002). Binary logistic regression analysis indicated that MVPA (18:00-20:00 pm) and other parameters, such as mean retinal nerve fiber layer (mRNFL), MD, mean arterial pressure (MAP), mean intro-ocular pressure (mIOP), age and gender were significantly correlated with POAG patients'progressive VF damage. Multivariate analysis showed that MVPA (odds ratio, OR (95% confidence intervals, CI) =0.96(0.94, 0.99), P=0.002), mRNFL (OR (95%CI) =0.97(0.94, 1.00), P=0.02),MAP (OR (95%CI) =0.88(0.83, 0.92), P<0.001), age (OR (95%CI) =1.10(1.06, 1.15), P<0.001) and gender (OR (95%CI) =0.44(0.22, 0.91), P=0.001) were still related to progressive VF loss after adjusting the other risk factors. CONCLUSIONS: Patients with POAG prefer to exercise more during 07:00-09:00 am, 15:00-17:00 pm and 18:00-20:00 pm. Less evening exercise is associated with glaucomatous progressive VF damage, with an increasing of one minute of MVPA time decreasing the progression of POAG about 4%.

Impact of ab-interno trabeculectomy on Bruch's membrane opening-based morphometry of the optic nerve head for glaucoma progression analysis.

To analyze the longitudinal change in Bruch's membrane opening minimal rim width (BMO-MRW) and circumpapillary retinal nerve fiber layer (RNFL) thickness using spectral domain optical coherence tomography (SD-OCT) after glaucoma surgery via ab-interno trabeculectomy in adult glaucoma patients. Retrospective audit of 65 eyes of 65 participants undergoing ab-interno trabeculectomy using electroablation of the trabecular meshwork. In 53 eyes, surgery was combined with phacoemulsification and posterior chamber lens implantation. Pre- and postoperative SD-OCT examinations of the optic nerve head (ONH), intraocular pressure (IOP), and visual field data were analyzed. Longitudinal change in morphometric SD-OCT parameters of the ONH was compared and correlated to change in IOP and visual field function. BMO-MRW increased significantly between baseline (BL) and follow-up (FU) within the first 6months after surgery (BL = 167.85 ± 90μm; FU = 175.59 ± 89μm; p = 0.034). This increase correlated with postoperative lowering of IOP (rho= - 0.41; p = 0.016). Nine months after surgery (range, 7-12months), there was no significant change in BMO-MRW (BL = 196.79 ± 79; FU = 196.47 ± 85μm; p = 0.95), while in later follow-up, a decrease of BMO-MRW was found (BL = 175.18 ± 78; FU = 168.65 ± 72; p = 0.05). RNFL thickness was unchanged in early (p > 0.16) and significantly decreased in later follow-up (p = 0.009). Mean deviation (MD) of visual field function did not show a significant change before and after surgery. Electroablative ab-interno trabeculectomy leads to a significant transient mild increase in BMO-MRW. This increase was shown to correlate with IOP lowering. Significant loss of BMO-MRW in later follow-up may reflect insufficient IOP reduction by surgery. The parameters RNFL thickness and MD seem less impacted directly by surgery.

Change of β-Zone Parapapillary Atrophy During Axial Elongation: Boramae Myopia Cohort Study Report 3.

To investigate changes of β-zone parapapillary atrophy (PPA) during axial elongation. Change of β-zone PPA was evaluated by spectral-domain optical coherence tomography (SD-OCT) in myopic children for 2 years, prospectively. Using the infrared images acquired by a fixed scan circle in the glaucoma progression analysis (GPA) mode, the retinal pigment epithelial opening (RPEO) and the clinical disc margin (CDM) were manually delineated. The area and position of β-zone PPA was calculated as the differences from those of the RPEO and CDM, respectively. The β-zone PPA was further differentiated into βBM PPA (β-zone PPA with Bruch's membrane [BM]) and γ-zone PPA (β-zone PPA without BM). The change of β-zone PPA was compared between the first and final visits. The area of β-zone PPA increased in 35 eyes (76%). This increase was associated with RPEO area increase and CDM area decrease. The center of β-zone PPA moved along the direction of vascular trunk dragging, but to a lesser extent. The β-zone PPA enlargement was correlated with the extent of vascular trunk dragging (P = 0.014). In all eyes with β-zone PPA increase, the γ-zone portion had increased. Even in childhood, βBM PPA existed next to their γ-zone PPA in 11 eyes (24%), including 4 eyes that showed increase of both γ-zone and βBM portion during axial elongation. Enlargement of β-zone PPA during axial elongation was affected by the extent and direction of vascular trunk dragging, thus implicating disproportionate growth between the retina and sclera.

Positional Change of Optic Nerve Head Vasculature during Axial Elongation as Evidence of Lamina Cribrosa Shifting: Boramae Myopia Cohort Study Report 2

To investigate the positional change of central retinal vasculature and vascular trunk to deduce the change in the lamina cribrosa (LC) during axial elongation. Prospective cohort study. Twenty-three healthy myopic children (46 eyes). Participants had undergone a full ophthalmologic examination and axial length measurement every 6 months for 2 years. Using spectral-domain OCT, circle scans centered around the optic disc in the glaucoma progression analysis mode, which enabled capturing of the same positions throughout the entire study period, and enhanced depth imaging of the deep optic nerve head complex were performed. Infrared imaging of the circle scans was used to measure the changes in the angles between the first and final visits. The angle between the major superior and inferior retinal arteries was measured along the circle scan twice: from the center of the circle scan and from the central retinal vascular trunk, respectively. The positional change of the retinal vascular trunk also was measured. Change in vascular angle and position of vascular trunk with axial elongation and associated factors. The vascular angle measured from the center of the circle scan did not change (P= 0.247), whereas the angle measured from the central retinal arterial trunk decreased with axial elongation (P < 0.001). A generalized estimating equation analysis revealed that the factors associated with angle decrease were axial elongation (P= 0.004) and vascular trunk dragging (P < 0.001). The extent of vascular trunk dragging was associated with axial elongation (P < 0.001) and increased border length with marginal significance (P= 0.053), but the extent of dragging could not be explained fully by their combination. The major directionality of dragging was mostly to the nasal side of the optic disc, with large variations among participants. During axial elongation, the retinal vasculature at the posterior pole was unchanged, whereas the position of the central vascular trunk was dragged nasally. Because the central retinal vascular trunk is embedded in the LC, its dragging indicates nasal shifting of the LC, which could explain the vulnerability of myopic eyes to glaucomatous optic neuropathy.

The Effective Dynamic Ranges for Glaucomatous Visual Field Progression With Standard Automated Perimetry and Stimulus Sizes III and V.

PurposeIt has been shown that threshold estimates below approximately 20 dB have little effect on the ability to detect visual field progression in glaucoma. We aimed to compare stimulus size V to stimulus size III, in areas of visual damage, to confirm these findings by using (1) a different dataset, (2) different techniques of progression analysis, and (3) an analysis to evaluate the effect of censoring on mean deviation (MD).MethodsIn the Iowa Variability in Perimetry Study, 120 glaucoma subjects were tested every 6 months for 4 years with size III SITA Standard and size V Full Threshold. Progression was determined with three complementary techniques: pointwise linear regression (PLR), permutation of PLR, and linear regression of the MD index. All analyses were repeated on “censored'' datasets in which threshold estimates below a given criterion value were set to equal the criterion value.ResultsOur analyses confirmed previous observations that threshold estimates below 20 dB contribute much less to visual field progression than estimates above this range. These findings were broadly similar with stimulus sizes III and V.ConclusionsCensoring of threshold values < 20 dB has relatively little impact on the rates of visual field progression in patients with mild to moderate glaucoma. Size V, which has lower retest variability, performs at least as well as size III for longitudinal glaucoma progression analysis and appears to have a larger useful dynamic range owing to the upper sensitivity limit being higher.

Is Obstructive Sleep Apnea Associated With Progressive Glaucomatous Optic Neuropathy?

The purpose of this study was to evaluate the relationship between obstructive sleep apnea syndrome (OSAS) and glaucoma progression, and to examine the correlation between OSAS severity and rate of visual field (VF) loss. Patients with concurrent diagnoses of open-angle glaucoma and OSAS between 2010 and 2016 were identified. Enrollment criteria consisted of glaucomatous optic neuropathy and VF loss, ≥5 reliable VFs, ≥2 years of follow-up, and polysomnography (PSG) within 12 months of final VF. PSG parameters including apnea-hypopnea index (AHI) and oxygen saturation (SpO2) were collected. Eyes were classified as "progressors" or "nonprogressors" based upon event analysis using Glaucoma Progression Analysis criteria. Two-tailed t test comparisons were performed, and correlations between rates of VF loss and PSG parameters were assessed. A total of 141 patients with OSAS and glaucoma were identified. Twenty-five patients (age 67.9±7.6 y) with OSAS (8 mild, 8 moderate, 9 severe) were enrolled. Eleven eyes (44%) were classified as progressors, and had more severe baseline VF loss (P=0.03). Progressors and nonprogressors had nonsignificantly different (P>0.05) age (69.9±8.7 vs. 66.4±6.6 y), follow-up (4.4±0.7 vs. 4.3±1.0 y), intraocular pressure (13.1±2.8 vs. 14.9±2.5 mm Hg), mean ocular perfusion pressure (49.7±5.5 vs. 48.8±9.0 mm Hg), AHI (31.3±18.6 vs. 26.4±24.0), body-mass index (27.8±5.5 vs. 28.8±5.6), and SpO2 (94.1±1.6% vs. 94.0±1.6%). AHI was not correlated with slopes of VF mean deviation (r, -0.271; P, 0.190) or pattern standard deviation (r, 0.211; P, 0.312), and no substantial increase in risk of progression was found with increase in AHI. This study does not support a relationship between OSAS and glaucomatous progression. No correlation was observed between OSAS severity and rate of VF loss.

Age-related changes in and determinants of macular ganglion cell-inner plexiform layer thickness in normal Chinese adults.

Consideration of age-related changes in macular ganglion cell-inner plexiform layer (mGCIPL) thickness are important for glaucoma progression analysis. To report age-related changes in and the determinants of high-definition optical coherence tomography (HD-OCT) measurements of mGCIPL thickness. Cross-sectional study. 326 healthy adults. All subjects underwent Cirrus HD-OCT measurements of mGCIPL. One-way analysis of variance (ANOVA) was used to compare mGCIPL thickness between 7 decades based age groups and macular sectors. Multiple regression analysis determined the association between mGCIPL thickness and age, gender, intraocular pressure (IOP), peripapillary retinal nerve fibre layer thickness (pRNFL) and spherical equivalent. Change in mGCIPL thickness and determinants of thickness. Mean mGCIPL thickness in 295 subjects was 80.80 ± 6.42 μm. Mean mGCIPL decreased by 0.12 μm (95% CI [confidence interval], 0.09-0.16) with every year of age; 1.61 μm (95% CI, 0.08-2.41) per decade. It showed two steep declines with age, first in the fifth and next in the seventh decade with relative stability between them. mGCIPL thickness was associated with pRNFL thickness (β = 0.30, P < 0.001) and IOP (β = -0.19, P = 0.03) but not with gender (β = -1.09, P = 0.116) or spherical equivalent (β = -0. 24, P = 0.145). Mean mGCIPL thickness showed a small age-related linear decrease with two steep drops in the fifth and seventh decades. Thinner mGCIPL was independently associated with age, thinner pRNFL and higher IOP. These factors should be considered if using mGCIPL to detect progression of glaucoma and other optic neuropathies characterized by the loss of retinal ganglion cells.

Non-parametric tests in detecting glaucoma progression.

Automated perimetry still represents the gold standard in long term glaucoma monitoring. On a daily practice basis, glaucoma progression analysis could be difficult due to the long time needed to detect, confirm, and quantify the progression rate. Moreover, "trend" and "event" analysis require a good theoretical basis to perform and interpret. Aim of study was to present an alternative method to conventional Glaucoma Progression Analysis (Humphrey Visual Field Analyzer, Carl Zeiss® Inc.) applied for the early detection of glaucoma progression. Such an "event" analysis orients the clinician in a fast manner on the progression profile in glaucoma patients and might adapt the follow up visits accordingly. Method and material: 41 eyes from 41 patients with open angle glaucoma were studied in a longitudinal manner, over a 24 months' time interval from diagnosis. Results: in the GPA analysis, a positive "event" (progression) was detected in 11/ 41 eyes (26.82%). Non-parametric analysis confirmed progression in all GPA cases, and additionally found 8 more eyes with positive progression (46.34% studied eyes). Mc Nemar concordance analysis between tests was good and relevant (kappa index k=0.596, p=0.000), with positive correlation (r=0.652, p=0.008). In conclusion, NPA tends to overestimate the number of progression cases in a cohort, but it can easily orient the clinician on the profile of the followed patients. In the first years, the GPA analysis can be highly inaccurate, but there is a great need to detect which patients are at significant risk for vision loss (fast progressors). Yet, combining the two methods of detection of glaucoma progression, the practitioners might direct their selected interest and attention towards observing a larger than expected number of patients who are at risk for vision loss over time due to glaucoma, but not necessarily in a fast manner.

5-year disease progression of patients across the glaucoma spectrum assessed by structural and functional tools

BackgroundAssessment of spectral-domain optical coherence tomography (SD-OCT) compared with visual fields, to detect progression across the glaucoma spectrum.MethodsIn this study, adult glaucoma suspects and patients, with baseline retinal nerve fibre...

Screening for glaucoma progression by using non‐parametric tests

PurposeAutomated perimetry still represents the gold standard in long term glaucoma monitoring.Early detection of progression tendency in glaucoma patients is crucial. Purpose of this study was to assess an alternative fast and convenient method compared to GPA (Humphrey Perimeter, Carl Zeiss®) for detecting glaucoma progression shortly after diagnosis‐24 months.MethodsWe studied in a longitudinal manner 41 eyes from 41 patients with early open angle glaucoma forms, followed in the first 24 months after diagnosis. Glaucoma was defined according to EGS criteria and a minimum of 5 valid visual fields were required form each patient. All specific glaucoma clinical data were recorded and progression was verified by two distinctive methods: Glaucoma Progression Analysis (GPA) software from Hymphrey Visual Field Analyzer and a non parametric analysis (NPA) according to Wesselink protocol.ResultsIn GPA analysis, a positive „event” (progression) was detected in 11/ 41 eyes, 26.82%. NPA confirmed progression in all GPA cases, but additionally detected 8 moreprogression cases (46.34% eyes). The concordance between tests was good (k = 0.596, p = 0.000), with positive correlation (Mc Nemar test r = 0.652, p = 0.008). In the first 2 years after diagnosis, GPA sensitivity was 26.82% and a specificity of 73.33%, whereas NPA sensitivity was 46.34% and comparable specificity 72.41% to GPA. Likelihood ratio for progression (LR) in GPA was 1.00 vs 1.51 for NPA analysis.ConclusionsNPA tends to overestimate progressor number in a cohort, but its purpose is to allert and orient the clinician on the progression profile of the followed patients. In the first years, the GPA analysis can be highly inaccurate, therefore combining two methods with similar specificity might aid this purpose and ease the glaucoma care management.

Will Perimetry Be Performed to Monitor Glaucoma in 2025?

Visual field testing has played an essential role in the diagnosis and management of glaucoma for more than a century. Methods to examine the visual field have been refined from early kinetic perimetry to current standard automated perimetry (SAP). Clinicians now use SAP for the diagnosis and management of glaucoma throughout the world. Various testing paradigms and analytic methods have been developed to simplify the diagnosis of glaucoma and the interpretation of progression. Moreover, strategies have been implemented to improve patient experience with visual field testing and to increase reliability. Objective functional tests, such as electroretinography, provide an alternative to subjective visual field testing but are not yet ready for widespread adoption. Standard automated perimetry is being adapted and improved constantly. New devices may allow patients to complete visual field tests at home, which could relieve patients and clinicians from in-office testing and allow for more frequent examinations. Glaucoma detection and progression analysis also are incorporating progressively more information and will be improved as deep learning strategies are applied. Finally, perimetric and structural testing likely will become more closely intertwined as testing platforms and progression analysis incorporate both of these measures. Visual field testing will continue to have an important role in the diagnosis and management of glaucoma.