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Original Investigation
February 2, 2017

Trend-Based Progression Analysis for Examination of the Topography of Rates of Retinal Nerve Fiber Layer Thinning in Glaucoma

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
  • 2Department of Mathematics and Statistics, Hang Seng Management College, Hong Kong, People’s Republic of China
JAMA Ophthalmol. Published online February 2, 2017. doi:10.1001/jamaophthalmol.2016.5111
Key Points

Question  Can topographic measurements of the rates of retinal nerve fiber layer thinning be used to indicate the risk of visual field loss in patients with glaucoma?

Findings  In this 5-year prospective cohort study of 89 patients (117 eyes), the peak and the mean rates of retinal nerve fiber layer thinning were associated with an increased risk of subsequent development of visual field worsening as measured by criteria of both the Early Manifest Glaucoma Trial and pointwise linear regression.

Meaning  Topographic measurements of the rates of retinal nerve fiber layer thinning are informative for risk assessment of visual field decline in patients with glaucoma.

Abstract

Importance  Measurement of the rates of retinal nerve fiber layer (RNFL) thinning has consisted primarily of the circumpapillary RNFL profile. This study reports the rates of RNFL thinning over the 6 × 6 mm2 RNFL thickness map and their application for indication of visual field (VF) worsening in patients with glaucoma.

Objective  To investigate the association between the rates of RNFL thinning and the risk of VF worsening in patients with glaucoma.

Design, Setting, and Participants  This prospective study included 117 eyes of 89 Chinese patients with primary open-angle glaucoma followed up at approximate 4-month intervals for 5 or more years between July 1, 2007, and October 30, 2015, with progressive RNFL thinning detected by optical coherence tomography trend-based progression analysis (TPA). The mean and the peak rates of RNFL thinning and the area of progressive RNFL thinning were measured by the rates of change of RNFL thickness map. Visual field worsening was determined by the Early Manifest Glaucoma Trial and pointwise linear regression criteria.

Main Outcomes and Measures  Hazard ratios (HRs) for indication of VF worsening determined by time-varying Weibull survival models.

Results  Of 89 patients (117 eyes) included in the study, 53 (59.6%) were men; mean (SD) age was 54.0 (13.8) years. At the time that progressive RNFL thinning was confirmed by TPA, the mean and the peak rates of RNFL thinning were 9.06 (8.05) µm/y and 4.52 (3.19) µm/y, respectively, and the area of progressive RNFL thinning was 1.54 (1.83) mm2. The inferotemporal meridians at 268° to 288° and the superotemporal meridians at 40° to 60° were the most frequent locations where progressive RNFL thinning was observed; 41.9% of the eyes had progressive RNFL thinning at these locations. After controlling for baseline covariates, the peak and the mean rates of RNFL thinning, but not the area of progressive RNFL thinning, were indicative of VF worsening. For each micrometer-per-year increase in the peak and the mean rates of RNFL thinning, the hazard ratios were 1.12 (95% CI, 1.04-1.19) for the peak rate and 1.39 (95% CI, 1.19-1.62) for the mean rate by the Early Manifest Glaucoma Trial criteria, and 1.07 (95% CI, 1.03-1.10) for the peak rate and 1.18 (95% CI, 1.09-1.28) for the mean rate by the pointwise linear regression criteria.

Conclusions and Relevance  Topographic measurement of the rates of RNFL thinning by optical coherence tomography TPA is informative for risk assessment of VF loss in glaucoma. Although progressive RNFL thinning may not necessarily be associated with VF worsening, faster rates of RNFL thinning were associated with a higher risk of subsequent decline in VF.

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