Advanced Imaging for Glaucoma Study: Design, Baseline Characteristics, and Inter-site Comparison

Self Cite

121

Purpose To compare longitudinal glaucoma progression detection using optical coherence tomography (OCT) and visual field (VF). Design Validity assessment Method We analyzed subjects with more than 5 follow-up visits (every 6 months) in the multi-center Advanced Imaging for Glaucoma Study. Fourier-domain optical coherence tomography (OCT) was used to map the thickness of the peripapillary retinal nerve fiber layer (NFL) and ganglion cell complex (GCC). OCT-based progression detection was defined as a significant negative trend for either NFL or GCC. VF progression was reached if either the event or trend analysis reached significance. Result The analysis included 417 glaucoma suspect/pre-perimetric glaucoma (GS/PPG) eyes and 377 perimetric glaucoma (PG) eyes. In the GS/PPG group, progression was detect in 38.9% of eyes by OCT, significantly more (P<0.001) than the detection rate of 18.7% by VF. In severity-stratified analysis of PG eyes, OCT had significantly higher detection rate in early PG (49.7% vs. 32.0%, p=0.02), but not significantly different in moderate and advanced PG. The rate of NFL thinning declined dramatically in advanced PG, but GCC thinning rate remained relatively steady and allowed good progression detection even in advanced disease. The rate of false positive progression detection in permutated series was over 10% for VF trend analysis in both GS/PPG and PG group, while under 7% for both GCC and NFL. Conclusion OCT is a more sensitive than VF for the detection of progression in early glaucoma. While the value of NFL declines in advanced glaucoma, GCC appears to be a useful progression detector from early to advanced stages.

Section: Methodsmentioning

confidence: 99%

Comparison of Glaucoma Progression Detection by Optical Coherence Tomography and Visual Field

Zhang

Dastiridou

Francis

et al. 2017

Self Cite

121

“…The study design and baseline participant characteristics have been published in a separate paper, 6 and the Manual of Procedures is available online (www.AIGStudy.net). Clinical data for the AIG Study was collected from three clinical centers, including the Doheny Eye Institute then at the University of Southern California (Now at University of California, Los Angeles), the University of Pittsburgh Medical Center, and Bascom Palmer Eye Institute at the University of Miami.…”

Section: Methodsmentioning

confidence: 99%

Predicting Development of Glaucomatous Visual Field Conversion Using Baseline Fourier-Domain Optical Coherence Tomography

Huang

Francis²,

Greenfield

et al. 2016

Self Cite

Purpose To predict the development of glaucomatous visual field (VF) defects using Fourier-domain optical coherence tomography (FD-OCT) measurements at baseline visit. Design Multi-center longitudinal observational study. Glaucoma suspects and pre-perimetric glaucoma participants in the Advanced Imaging for Glaucoma Study. Methods The optic disc, the peripapillary retinal nerve fiber layer (NFL), and macular ganglion cell complex (GCC) were imaged with FD-OCT VF was assessed every 6 months. Conversion to perimetric glaucoma was defined by VF pattern standard deviation (PSD) or glaucoma hemifield test (GHT) outside normal limits on 3 consecutive tests. Hazard ratios were calculated with the Cox proportional hazard model. Predictive accuracy was measured by the area under the receiver-operating-characteristic curve (AUC). Results Of 513 eyes (309 participants), 55 eyes (46 participants) experienced VF conversion during 41 ± 23 months of follow-up. Significant (p<0.05, Cox regression) FD-OCT risk factors included all GCC, NFL, and disc variables, except for horizontal cup-to-disc ratio. GCC focal loss volume (FLV) was the best single predictor of conversion (AUC=0.753, p<0.001 for test against AUC = 0.5). Those with borderline or abnormal GCC-FLV had a 4-fold increase in conversion risk after 6 years (Kaplan-Meier). Optimal prediction of conversion was obtained using the glaucoma composite conversion index (GCCI) based on a multivariate Cox regression model that included GCC-FLV, inferior NFL quadrant thickness, age, and VF PSD. GCCI significantly improved predictive accuracy (AUC=0.783) over any single variable (p=0.04). Conclusions Reductions in NFL and GCC thickness can predict the development of glaucomatous VF loss in glaucoma suspects and pre-perimetric glaucoma patients.

“…The data analyzed in this article came from participants in the perimetric glaucoma (PG) arm of the AIG Study. 20 These participants were enrolled at the Bascom Palmer Eye Institute, University of Miami; the Doheny Eye Institute (then affiliated with University of Southern California), and the University of Pittsburgh Medical Center Eye Institute. The Institutional Review Board (IRB) of each participating university approved the study protocol.…”

Section: Methodsmentioning

confidence: 99%

“…20 The purpose of this article is to identify baseline FD-OCT structural predictors for the progression of glaucomatous visual field (VF) defects, using the longitudinal AIG Study perimetric glaucoma cohort.…”

Section: Introductionmentioning

confidence: 99%

Baseline Fourier-Domain Optical Coherence Tomography Structural Risk Factors for Visual Field Progression in the Advanced Imaging for Glaucoma Study

Zhang

Dastiridou

Francis

et al. 2016

Self Cite

Purpose To identify baseline structural parameters that predict the progression of visual field (VF) loss in patients with open angle glaucoma. Design Multicenter cohort study. Methods Participants from Advanced Imaging for Glaucoma (AIG) study were enrolled and followed-up. VF progression is defined as either a confirmed progression event on Humphrey Progression Analysis or a significant (p<0.05) negative slope for VF index (VFI). Fourier-domain optical coherence tomography (FD-OCT) was used to measure optic disc, peripapillary retinal nerve fiber layer (NFL) and macular ganglion cell complex (GCC) thickness parameters. Results 277 eyes of 188 participants were followed up for 3.7 ± 2.1 years. VF progression was observed in 83 eyes (30%). Several baseline NFL and GCC parameters, but not disc parameters, were found to be significant predictors of progression on univariate Cox regression analysis. The most accurate single predictors were the GCC focal loss volume (FLV), followed closely by NFL-GCC. An abnormal GCC-FLV at baseline increased risk of progression by a hazard ratio of 3.1. Multivariate Cox analysis showed that combining age and central corneal thickness with GCC-FLV in a composite index called “Glaucoma Composite Progression Index” (GCPI) further improved the accuracy of progression prediction. GCC-FLV and GCPI were both found to be significantly correlated with the annual rate of change in VFI. Conclusion Focal GCC and NFL loss as measured by FD-OCT are the strongest predictors for VF progression among the measurements considered. Older age and thinner central corneal thickness can enhance the predictive power using the composite risk model.