Glaucoma Progression Research Articles

AGREEMENT OF MELBOURNE RAPID FIELDS PERIMETRY PARAMETERS TO HUMPHREY FIELD ANALYZER IN MODERATE-SEVERE GLAUCOMA PATIENTS: RELATIONSHIP BETWEEN VISUAL ACUITY AND MELBOURNE RAPID FIELDS ACCURACY

Introduction & ObjectivesPerimetric examination is vital for measuring visual field defects and predicting the progression ofglaucoma. The Covid-19 pandemic prompted the use of perimetry at home. Tablet or website-basedperimetry becomes an option due to unavailability of Humphrey Field Analyzer (HFA). MelbourneRapid Fields (MRF) is affordable, portable and reliable, even provide the same benefits as HFA. Thisstudy aimed to assess the agreement of MRF results to HFA in moderate-severe glaucoma patientswith impaired visual acuity.
 MethodsObservational study using a cross-sectional design to assess the relationship between visual acuityand the agreement of MRF vs HFA in moderate-severe glaucoma patients. Subjects were groupedinto two groups based on visual acuity. Each subject was examined with MRF and HFA, the order ofexamination was randomized using block randomization.
 ResultsThe test durations were shorter on MRF than HFA (265.7±26.6 vs 384.4±46.7, P<0.001). There wasno significant difference in the reliability index of the two perimetry. MRF showed a high level ofconcordance in its outcomes with HFA (R=0.931, intraclass correlation coefficient (ICC)=0.957 formean defect (MD) and R=0.941, ICC=0.974 for Visual Field Index (VFI)). MRF also showed levels oftest-retest repeatability comparable to HFA (R=0.948, ICC=0.989 for MD and R=0.946, ICC=0.989for Visual Capacity (VC)). There was no correlation between visual acuity and MRF accuracy,p>0.05.
 ConclusionThe perimetry results from MRF have a very stong correlation to the HFA outcomes. MRF also hastest-retest repeatability comparable to HFA. The accuracy of the MRF results does not correlate withvisual acuity.

COMPARISON OF SITA STANDARD 24-2 WITH SITA FASTER 24-2C PROGRAM ON HUMPHREY FIELD ANALYZER IN ASSESSING VISUAL FIELD DEFECTS OF GLAUCOMA PATIENTS

Introduction: Periodical perimetry examination to detect and determine the rate of glaucoma progression continues to be a challenging task, because it depends on many factors. Besides, there is now a paradigm shift which central visual field defects occur earlier. SITA Standard (SS) 24-2 is the clinical standard for glaucoma examination, but there were studies reporting on the prevalence of central visual field defects not detected. SITA Faster (SFR) 24-2C was developed to address current shortcomings, but the performance has yet to be formally and independently assessed. Objective: To compare the global indices (Mean Deviation, Pattern Standard Deviation, Visual Field Index) and test duration between SS 24-2 and SFR 24-2C program. Methods: This is an analytical observational study with a cross-sectional design. Subjects aged >18 years who diagnosed with glaucoma and whose visual fields unaffected by other condition besides glaucoma were included. All subjects underwent testing of both programs. Results: This study was conducted in 94 eyes of 66 patients. Comparison of global indices and test duration between the two programs was carried out by the Wilcoxon test. The mean results of MD and PSD global indices were not significantly different, however there was a difference in the mean VFI of 1.5% between the two programs. The test duration of SFR 24-2C was 55.03% faster. Conclusion: There was no significant difference in the MD and PSD global indices, but there was a significant difference in the VFI, as well as the test duration between the two programs.

Outcomes of Boston Keratoprosthesis Type I Implantation in Poland: A Retrospective Study on 118 Patients.

Background: Boston Keratoprosthesis Type I (BI-KPro I) is a synthetic cornea that can be used to restore vision in patients with corneal blindness. This retrospective study evaluated the outcomes of BI-KPro implantation in 118 patients. Material: The mean age of the patients was 56.76 ± 14.24 years. Indications for keratoprosthesis implantation were as follows: graft failure, 47 (39.83%); ocular burn, 38 (32.20%); neurotrophic keratopathy, 11 (9.32%), mucous membrane pemphigoid 9 (7.67%); autoimmune, 6 (5.08%); Stevens-Johnson syndrome, 4 (3.39%); and aniridia (2.54%). Methods: The surgeries were performed between March 2019 and June 2022 at a single clinical center in two locations. The postoperative visual acuity, complications, and need for additional surgical procedures were analyzed. Results: The Best Corrected Visual Acuity before surgery was 0.01 ± 0.006. After one year (V1), it was 0.30 ± 0.27; at two years (V2), it was 0.27 ± 0.26; and at three years (V3), it was 0.21 ± 0.23. The percentage of patients with visual acuity better than 0.1 on the Snellen chart was 37.29% after 1 year, 49.35% after 2 years, and 46.81% after 3 years of follow up. The most common complications were glaucoma (78 patients; 66.1%), corneal melting (22 patients; 18.6%), and retroprosthetic membranes (20 patients; 17.0%). Conclusions: The BI-KPro can significantly improve visual acuity. The worst long-term results were obtained in the group of patients with autoimmune diseases; therefore, careful consideration should be given to implanting BI-KPro in this group. The high incidence of de novo glaucoma or the progression of pre-existing glaucoma suggests the need for careful monitoring.

MiR-196b-5p regulates inflammatory process and migration via targeting Nras in trabecular meshwork cells

Glaucoma, an insidious ophthalmic pathology, is typified by an aberrant surge in intraocular pressure (IOP) which culminates in the degeneration of retinal ganglion cells and optical neuropathy. The mitigation of IOP stands as the principal therapeutic strategy to forestall vision loss. The trabecular meshwork's (TM) integrity and functionality are pivotal in modulating aqueous humor egress. Despite their potential significance in glaucomatous pathophysiology, the implications of microRNAs (miRNAs) on TM functionality remain largely enigmatic. Transcriptomic sequencing was employed to delineate the miRNA expression paradigm within the limbal region of rodent glaucoma models, aiming to elucidate miRNA-mediated mechanisms within the glaucomatous milieu. Analytical scrutiny of the sequencing data disclosed 174 miRNAs with altered expression profiles, partitioned into 86 miRNAs with augmented expression and 88 with diminished expression. Notably, miRNAs such as hsa-miR-196b-5p were identified as having substantial expression discrepancies with concomitant statistical robustness, suggesting a potential contributory role in glaucomatous progression. Subsequent in vitro assays affirmed that miR-196b-5p augments the inflammatory cascade within immortalized human TM (iHTM) and glaucoma-induced human TM (GTM3) cells, concurrently attenuating cellular proliferation, motility, and cytoskeletal architecture. Additionally, miR-196b-5p implicates itself in the regulation of IOP and inflammatory processes in rodent models. At a mechanistic level, miR-196b-5p modulates its effects via the targeted repression of Nras (neuroblastoma RAS viral oncogene homolog). Collectively, these transcriptomic investigations furnish a comprehensive vista into the regulatory roles of miRNAs within the glaucomatous framework, and the identification of differentially expressed miRNAs alongside their targets could potentially illuminate novel molecular pathways implicated in glaucoma, thereby aiding in the development of innovative therapeutic avenues.

Role of mechanically-sensitive cation channels Piezo1 and TRPV4 in trabecular meshwork cell mechanotransduction.

Glaucoma is one of the leading causes of irreversible blindness in developed countries, and intraocular pressure (IOP) is primary and only treatable risk factor, suggesting that to a significant extent, glaucoma is a disease of IOP disorder and pathological mechanotransduction. IOP-lowering ways are limited to decreaseing aqueous humour (AH) production or increasing the uveoscleral outflow pathway. Still, therapeutic approaches have been lacking to control IOP by enhancing the trabecular meshwork (TM) pathway. Trabecular meshwork cells (TMCs) have endothelial and myofibroblast properties and are responsible for the renewal of the extracellular matrix (ECM). Mechanosensitive cation channels, including Piezo1 and TRPV4, are abundantly expressed in primary TMCs and trigger mechanostress-dependent ECM and cytoskeletal remodelling. However, prolonged mechanical stimulation severely affects cellular biosynthesis through TMC mechanotransduction, including signaling, gene expression, ECM remodelling, and cytoskeletal structural changes, involving outflow facilities and elevating IOP. As for the functional coupling relationship between Piezo1 and TRPV4 channels, inspired by VECs and osteoblasts, we hypothesized that Piezo1 may also act upstream of TRPV4 in glaucomatous TM tissue, mediating the activation of TRPV4 via Ca2+ inflow or Ca2+ binding to phospholipase A2(PLA2), and thus be involved in increasing TM outflow resistance and elevated IOP. Therefore, this review aims to help identify new potential targets for IOP stabilization in ocular hypertension and primary open-angle glaucoma by understanding the mechanical transduction mechanisms associated with the development of glaucoma and may provide ideas into novel treatments for preventing the progression of glaucoma by targeting mechanotransduction.

Ten-Year Outcome of Boston Type I Keratoprosthesis Surgery at a Tertiary Care Center.

The aim of this study was to report long-term outcomes of patients who have undergone Boston type I keratoprosthesis (KPro) surgery. This study was a retrospective review. Inclusion criteria were KPro surgery between 2006 and 2012 and at least 10 years of follow-up. Demographics, ocular history, surgery indication, clinical variables, and postsurgical outcomes were recorded. Descriptive statistical analysis was performed. We identified 75 patients with KPro implantation, and 17 patients with at least 10 years of follow-up (median = 11.1 years; range, 10.0-12.8 years) were included. Of 17 eyes, 11 (64.8%) had their original device in situ, 3 (17.6%) had their second device in situ, 1 (5.9%) had the device removed and replaced with a donor keratoplasty, and 2 (11.8%) were enucleated. At the last follow-up, 11 eyes (64.7%) were able to maintain improvement in vision, 5 (29.4%) had worsened vision, 1 (5.9%) had stable vision, and 9 (52.9%) had visual acuity <Snellen 20/200. Major complications included infectious keratitis (n = 5, 29.4%), hypotony (n = 4, 23.5%), retinal detachment (n = 4, 23.5%), endophthalmitis (n = 2, 11.8%), and retroprosthetic membrane (n = 7, 50%). In addition, 15 eyes (88.2%) required glaucoma surgery. All but 1 eye lost best-ever visual acuity with 9 eyes (52.9%) because of glaucoma progression. KPro had an acceptable retention proportion and remains a viable option for eyes at high risk of failure with donor keratoplasty. However, subsequent surgeries are commonly performed postoperatively to manage complications. Glaucoma seems to be the main etiology of irreversible vision loss.

Rates of visual field change and functional progression in glaucoma following trabecular microbypass implantation of iStent technologies: a meta-analysis

Background/aimWhile intraocular pressure (IOP) remains the only modifiable risk factor for glaucoma progression, the ultimate goal of glaucoma management is to preserve patients’ functional vision and quality of life. To...

Effect of Sleeping Position on the Retinal Nerve Fiber Layer in Individuals with Glaucoma.

To evaluate the effect of sleeping in the lateral decubitus position on the average thickness of the retinal nerve fiber layer (RNFL) in the peripapillary region of the optic nerve since the effect of posture on intraocular pressure (IOP) and glaucoma progression is not yet sufficiently understood. A cross-sectional observational study was carried out with 40 volunteers who preferably slept in a right lateral decubitus (RLD) (RLD group N = 20) and left lateral decubitus (LLD) (LLD group N = 20) position. IOP was measured in both eyes, first in the sitting position and again after 10 minutes in a supine position, right lateral, and LLD, respectively. The mean thickness of the RNFL and the vertical papillary cup were measured by optical coherence tomography. The average age of the volunteers was 60.53 ± 7.26 years. There were 32 female and eight male. There was an increase in IOP with the change from the sitting position to the lateral decubitus of 2.7 and 3.6 mm Hg in the RLD group (p < 0.001) and an increase of 3.0 and 3.15 mm Hg in the LLD group (p < 0.001), right eye (RE) vs left eye (LE), respectively. However, there was no difference in IOP values between the groups. The average thickness of the RNFL was in the RLD group-75.10 vs 78.05 μm (p = 0.325) and in the LLD group-81.55 vs 79.95 μm (p = 0.580). Vertical papillary excavation was in the RLD group-0.70 vs 0.65 (p = 0.175) and in the LLD group-0.65 vs 0.65 (p = 1.000), RE vs LE, respectively. We found no relationship between the lateral decubitus position when adopted preferentially for sleeping and the reduction of the RNFL. Search for risk factors for the asymmetrical development of glaucoma, especially in well-controlled IOP in daytime measurements. Vaz RT, Montenegro AAL, Quintas Segundo ADS, et al. Effect of Sleeping Position on the Retinal Nerve Fiber Layer in Individuals with Glaucoma. J Curr Glaucoma Pract 2024;18(2):57-62.

Central visual field in glaucoma: An updated review.

Evaluation of central vision in glaucoma is important due to its impact on patients' quality of life and activities of daily living such as reading, driving, and walking. The 10-2 visual field (VF) assessment remains a mainstay in the functional analysis of central vision in glaucoma diagnosis and progression. However, it may be underutilized in clinical practice. Monitoring of disease progression especially in advanced cases, glaucoma evaluation in certain ocular disorders such as high myopia, disc hemorrhage, low corneal hysteresis, and certain optic disc phenotypes, as well as earlier detection of central VF damage, are certain conditions where additional monitoring with the 10-2 pattern may provide complementary clinical information to the commonly utilized 24-2 pattern. In addition, the development of artificial intelligence techniques may assist clinicians to most effectively allocate limited resources by identifying more risk factors to central VF damage. In this study, we aimed to determine specific patient characteristics that make central VF damage more likely and to assess the benefit of incorporating the 10-2 VF in various clinical settings.

Big data for imaging assessment in glaucoma.

Glaucoma is the leading cause of irreversible blindness worldwide, with many individuals unaware of their condition until advanced stages, resulting in significant visual field impairment. Despite effective treatments, over 110 million people are projected to have glaucoma by 2040. Early detection and reliable monitoring are crucial to prevent vision loss. With the rapid development of computational technologies, artificial intelligence (AI) and deep learning (DL) algorithms are emerging as potential tools for screening, diagnosing, and monitoring glaucoma progression. Leveraging vast data sources, these technologies promise to enhance clinical practice and public health outcomes by enabling earlier disease detection, progression forecasting, and deeper understanding of underlying mechanisms. This review evaluates the use of Big Data and AI in glaucoma research, providing an overview of most relevant topics and discussing various models for screening, diagnosis, monitoring disease progression, correlating structural and functional changes, assessing image quality, and exploring innovative technologies such as generative AI.

Application of artificial intelligence in glaucoma care: An updated review.

The application of artificial intelligence (AI) in ophthalmology has been increasingly explored in the past decade. Numerous studies have shown promising results supporting the utility of AI to improve the management of ophthalmic diseases, and glaucoma is of no exception. Glaucoma is an irreversible vision condition with insidious onset, complex pathophysiology, and chronic treatment. Since there remain various challenges in the clinical management of glaucoma, the potential role of AI in facilitating glaucoma care has garnered significant attention. In this study, we reviewed the relevant literature published in recent years that investigated the application of AI in glaucoma management. The main aspects of AI applications that will be discussed include glaucoma risk prediction, glaucoma detection and diagnosis, visual field estimation and pattern analysis, glaucoma progression detection, and other applications.

Efektivitas Tetes Mata Citicoline terhadap Perbaikan Lapang Pandang dan Ketebalan Lapisan Serabut Saraf Retina pada Glaukoma Primer Sudut Terbuka

Primary open-angle glaucoma (POAG) is the second leading cause of irreversible blindness worldwide with increasing prevalence. Oral citicoline has been shown to have a role in glaucoma; however, studies regarding citicoline eye drops for glaucoma are still limited. This is a critical appraisal of the literature on the effectiveness of citicoline in improving the mean deviation (MD) of the visual field and thickness of the retinal nerve fiber layer (RNFL) in POAG. A literature search was done on 4 databases: PubMed, Cochrane, Embase, and Scopus. From the 165 studies initially identified, 3 studies were qualified for critical review. Rossetti demonstrated significant MD (p=0.02) and RNFL (p=0.04) differences after 3 years of citicoline eye drops compared to placebo. Mirachtsis showed that after citicoline administration for 3 months there was a significant difference in RNFL (p=0.029), but no significant improvement in MD (p&gt;0.05). Parisi showed an improvement in MD after 4 months (+0.56 dB) and 6 months (+0.18 dB) of citicoline administration. Citicoline eye drops have the potential to inhibit glaucoma progression by inhibiting RNFL loss, but further research is needed on visual field improvement.

Different glaucoma progression rates by age groups in young myopic glaucoma patients

We aimed to investigate the age-related glaucoma progression rates in myopic normal tension glaucoma (NTG). In this long-term retrospective cohort (7.2 ± 3.5 years), we grouped patients based on their age at initial presentation: group A (age < 30 years, 60 eyes), group B (30 ≤ age < 40, 66 eyes), and group C (40 ≤ age < 50 years, 63 eyes). We used a linear mixed-effects model to estimate retinal nerve fiber layer (RNFL) defect width enlargement rates. Group A showed a significantly faster rate of RNFL defect progression (3.01 ± 1.74°/year) than those of groups B and C (2.05 ± 1.55°/year and 2.06 ± 1.29°/year, P = 0.004 and 0.002). The difference was more marked when calculated for the first 10 years of follow-up in group A, B, and C (3.95 ± 2.70°/year, 2.39 ± 1.64°/year, and 1.98 ± 1.31°/year), and between the periods of age < 30 years, 30 ≤ age < 40 years, and 40 ≤ age < 50 years within group A. This is the first evidence of rapid glaucoma progression in the young adulthood and stabilization in older age in myopic NTG. Clinicians should consider the potentially aggressive course of glaucoma, especially in younger patients with myopic NTG, in contrast to the general slow progression in adulthood.

Longitudinal changes in optical coherence tomography angiography characteristics in normal-tension glaucoma with or without high myopia.

To evaluate the structural, microvascular, and functional progression of normal tension glaucoma (NTG) with or without high myopia by examining longitudinal changes in optical coherence tomography angiography (OCTA) and visual field (VF) parameters. We evaluated 61 NTG eyes and classified 25 of the eyes with axial lengths (ALs) of ≥26 mm as highly myopic. We assessed the rate of change in OCTA parameters, namely radial peripapillary capillary (RPC) vessel density (VD), parafovea VD, deep parafovea VD, retinal nerve fibre layer (RNFL) thickness, and ganglion cell complex thickness. We evaluated the correlation of the rate of change in OCTA parameters with VF loss and AL. Among the 61 NTG eyes, rates of loss of RPC VD, parafovea VD, deep parafovea VD, and RNFL thickness were significantly different from zero despite the nonsignificant rate of change in VF mean deviation (MD). Changes in these OCTA parameters did not differ significantly in highly myopic NTG eyes. The rate of change in VF MD was significantly correlated with the rate of change in parafovea VD in highly myopic and non-highly myopic NTG eyes. In highly myopic NTG eyes, AL was negatively correlated with the rates of loss of RNFL thickness, VF MD, and VF PSD. NTG eyes with a relatively stable VF exhibited loss of VD and RNFL thickness. VF progression in NTG was correlated with decreasing parafovea VD, indicating a structure-function correlation. Greater AL may indicate faster VF loss and RNFL thinning in highly myopic NTG eyes.

The association between glaucoma treatment adherence with disease progression and loss to follow-up

Prospective cohort study from Brazil to evaluate glaucoma treatment adherence using a medication event monitoring system (MEMS) device and correlate with glaucoma progression and loss to follow-up (LTF) after one year of follow up. We included primary open glaucoma (POAG) patients treated with at least one ocular hypotensive eye drop. MEMS devices was used to monitor adherence for 60 days and evaluate the percentage of doses prescribed taken within the 60-day period. We classified patients according to rates of adherence: low adherence (less than 75% from MEMS measurements) and high adherence (more than 75% from MEMS measurements). We applied a questionnaire to investigated self-reported behavior towards treatment behaviors (glaucoma treatment compliance assessment tool, GTCAT). We also correlated rates of treatment adherence with clinical, demographical variables and the occurrence of glaucoma progression or LTF after one year of observation. We included 110 POAG patients and found that 28.18% of them were considered low adherent. We identify several variables associated with poor adherence such as glaucoma progression, LTF, younger age, low educational and income levels, absence of health insurance, years of disease and peak intraocular pressure. Several constructs from the self-reported GTCAT were also correlated with the rates of treatment adherence. To date, this is the first study in Latin America to evaluate glaucoma treatment adherence with MEMS devices and correlate adherence rates with glaucoma progression and LTF. We found a low-adherence rate of 28.18% and several additional risk factors were statistically associated with poor adherence.

Comparison of the Circumpapillary Structure-Function and Vasculature-Function Relationships at Different Glaucoma Stages Using Longitudinal Data.

This study investigated the global and regional correlations between longitudinal structure-function (S-F) and vasculature-function (V-F) data using circumpapillary retinal nerve fiber layer thickness (cpRNFLT) measurements from optical coherence tomography (OCT), circumpapillary vessel density (cpVD) from OCT angiography (OCTA), and the corresponding visual field mean sensitivities at different glaucoma stages. A total of 107 eyes from 107 glaucoma patients with progressive visual field (VF) changes followed up for an average of 3.33 ± 1.39years were enrolled, including early-to-moderate (51 eyes) and advanced (56 eyes) stages. The rates of longitudinal change in the VF mean deviation (MD), cpRNFLT, and cpVD were evaluated using linear mixed-effects models and compared between different glaucoma stages. Longitudinal global and regional S-F and V-F relationships were assessed by repeated measures correlation analysis by glaucoma stage. No significant differences were found in the rates of VF MD and cpVD changes (P > 0.05) between the two glaucoma stage groups. CpRNFLT decreased more rapidly in the early-to-moderate stage group (P < 0.001) in which significant longitudinal global and regional correlations were found in both S-F and V-F relationships (all P < 0.05), except for the nasal sector. Significant global and regional correlations were only found in V-F relationship in advanced stage cases (all P < 0.05). Significant longitudinal V-F relationships exist globally and regionally regardless of glaucoma stage but no longitudinal S-F relationship is present in advanced glaucoma. Longitudinal follow-up of cpVD parameters may be useful for monitoring glaucomatous VF progression at all disease stages.

Risk Factors for Progression of Primary Open-Angle Glaucoma with Lower Normal Intraocular Pressure

Introduction: This study aimed to investigate intraocular pressure (IOP)-independent factors associated with the progression of primary open-angle glaucoma (POAG) with IOP ≤15 mm Hg. Methods: POAG patients with maximum IOP ≤15 mm Hg at the Kyoto University Hospital between January 2011 and August 2021 were retrospectively enrolled. We evaluated effects of various factors on the rate of mean deviation (MD) changes in the visual field (VF) examinations using a linear mixed model. These factors included hypertension, diabetes mellitus (DM), hyperlipidemia (HL), cardiovascular disease, arrhythmia, disc hemorrhage, sleep apnea syndrome, orthopedic diseases, and malignant tumors. Results: In total, 98 eyes from 68 patients were included. The baseline MD was −9.74 ± 7.85 dB. The mean rate of MD change and IOP during the observation period were −0.28 ± 0.04 dB/year and 11.8 ± 1.0 mm Hg, respectively. Comorbidity of DM or HL showed a significant positive association with the rate of MD change (β = 0.35, p = 0.0006 and β = 0.18, p = 0.036, respectively) in the model adjusted for age, sex, axial length, mean IOP, and standard deviation of IOP during the observation period. However, no significant association of DM or HL was found after adjusting for central corneal thickness. Conclusion: This study suggests that DM or HL is associated with VF deterioration in glaucoma with lower IOP, but the association may be due to differences in IOP characteristics.

Frontloading visual field tests detect earlier mean deviation progression when applied to real-world-derived early-stage glaucoma data.

To examine the diagnostic accuracy of performing two (frontloaded) versus one (clinical standard) visual field (VF) test per visit for detecting the progression of early glaucoma in data derived from clinical populations. A computer simulation model was used to follow the VFs of 10,000 glaucoma patients (derived from two cohorts: Heijl etal., Swedish cohort; and Chauhan etal., Canadian Glaucoma Study [CGS]) over a 10-year period to identify patients whose mean deviation (MD) progression was detected. Core data (baseline MD and progression rates) were extracted from two studies in clinical cohorts of glaucoma, which were modulated using SITA-Faster variability characteristics from previous work. Additional variables included follow-up intervals (six-monthly or yearly) and rates of perimetric data loss for any reason (0%, 15% and 30%). The main outcome measures were the proportions of progressors detected. When the Swedish cohort was reviewed six-monthly, the frontloaded strategy detected more progressors compared to the non-frontloaded method up to years 8, 9 and 10 of follow-up for 0%, 15% and 30% data loss conditions. The time required to detect 50% of cases was 1.0-1.5 years less for frontloading compared to non-frontloading. At 4 years, frontloading increased detection by 26.7%, 28.7% and 32.4% for 0%, 15% and 30% data loss conditions, respectively. Where both techniques detected progression, frontloading detected progressors earlier compared to the non-frontloaded strategy (78.5%-81.5% and by 1.0-1.3 years when reviewed six-monthly; 81%-82.9% and by 1.2-2.1 years when reviewed yearly). Accordingly, these patients had less severe MD scores (six-monthly review: 0.63-1.67 dB 'saved'; yearly review: 1.10-2.87 dB). The differences increased with higher rates of data loss. Similar tendencies were noted when applied to the CGS cohort. Frontloaded VFs applied to clinical distributions of MD and progression led to earlier detection of early glaucoma progression.

Prediction and Detection of Glaucomatous Visual Field Progression Using Deep Learning on Macular Optical Coherence Tomography.

A deep learning model trained on macular OCT imaging studies detected clinically significant functional glaucoma progression and was also able to predict future progression. To use macular optical coherence tomography (OCT) imaging to predict the future and detect concurrent visual field progression, respectively, using deep learning. A retrospective cohort study. A pretraining data set was comprised of 7,702,201 B-scan images from 151,389 macular OCT studies. The progression detection task included 3902 macular OCT imaging studies from 1534 eyes of 828 patients with glaucoma, and the progression prediction task included 1346 macular OCT studies from 1205 eyes of 784. A novel deep learning method was developed to detect glaucoma progression and predict future progression using macular OCT, based on self-supervised pretraining of a vision transformer (ViT) model on a large, unlabeled data set of OCT images. Glaucoma progression was defined as a mean deviation (MD) rate of change of ≤ -0.5 dB/year over 5 consecutive Humphrey visual field tests, and rapid progression was defined as MD change ≤ -1 dB/year. Diagnostic performance of the ViT model for prediction of future visual field progression and detection of concurrent visual field progression using area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. The model distinguished stable eyes from progressing eyes, achieving an AUC of 0.90 (95% CI, 0.88-0.91). Rapid progression was detected with an AUC of 0.92 (95% CI, 0.91-0.93). The model also demonstrated high predictive ability for forecasting future glaucoma progression, with an AUC of 0.85 (95% CI 0.83-0.87). Rapid progression was predicted with an AUC of 0.84 (95% CI 0.81-0.86). A deep learning model detected clinically significant functional glaucoma progression using macular OCT imaging studies and was also able to predict future progression. Early identification of patients undergoing glaucoma progression or at high risk for future progression may aid in clinical decision-making.

Assessment of linear regression of peripapillary optical coherence tomography retinal nerve fiber layer measurements to forecast glacuoma trajectory.

Linear regression of optical coherence tomography measurements of peripapillary retinal nerve fiber layer thickness is often used to detect glaucoma progression and forecast future disease course. However, current measurement frequencies suggest that clinicians often apply linear regression to a relatively small number of measurements (e.g., less than a handful). In this study, we estimate the accuracy of linear regression in predicting the next reliable measurement of average retinal nerve fiber layer thickness using Zeiss Cirrus optical coherence tomography measurements of average retinal nerve fiber layer thickness from a sample of 6,471 eyes with glaucoma or glaucoma-suspect status. Linear regression is compared to two null models: no glaucoma worsening, and worsening due to aging. Linear regression on the first M ≥ 2 measurements was significantly worse at predicting a reliable M+1st measurement for 2 ≤ M ≤ 6. This range was reduced to 2 ≤ M ≤ 5 when retinal nerve fiber layer thickness measurements were first "corrected" for scan quality. Simulations based on measurement frequencies in our sample-on average 393 ± 190 days between consecutive measurements-show that linear regression outperforms both null models when M ≥ 5 and the goal is to forecast moderate (75th percentile) worsening, and when M ≥ 3 for rapid (90th percentile) worsening. If linear regression is used to assess disease trajectory with a small number of measurements over short time periods (e.g., 1-2 years), as is often the case in clinical practice, the number of optical coherence tomography examinations needs to be increased.