Can Macula and Optic Nerve Head Parameters Detect Glaucoma Progression in Eyes with Advanced Circumpapillary Retinal Nerve Fiber Layer Damage?

Lavinsky, Fábio; Wu, Mengfei; Schuman, Joel S.; Lucy, Katie A.; Liu, Mengling; Song, Youngseok; Fallon, Julia; Cadena, Maria de los Angeles Ramos; Ishikawa, Hiroshi; Wollstein, Gadi

doi:10.1016/j.ophtha.2018.05.020

Cited by 59 publications

(39 citation statements)

References 27 publications

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“…Cross-sectional studies have reported the "floor effect" of RNFL thickness at approximately 50 µm with Spectralis OCT, the level at which point no additional thinning can be distinguished [23][24][25] . Longitudinal studies have, however, shown that structural progression can still be seen in late stage disease and that the floor effects only occur at thinner RNFL values, which is in agreement with the present study 26,27 . Also, postmortem studies suggested that a few surviving ganglion cells remain detected in cases of advanced glaucoma 28 .…”

Section: Discussionsupporting

confidence: 93%

One year structural and functional glaucoma progression after trabeculectomy

Chua

Kadziauskiene

Wong

et al. 2020

Sci Rep

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We evaluated the changes in visual field mean deviation (VF MD) and retinal nerve fibre layer (RNFL) thickness in glaucoma patients undergoing trabeculectomy. one hundred patients were examined with VF and spectral-domain optical coherence tomography (OCT) before trabeculectomy and 4 follow-up visits over one year. Linear mixed models were used to investigate factors associated with VF and RNFL. VF improved during the first 3 months of follow-up (2.55 ± 1.06 dB/year) and worsened at later visits (−1.14 ± 0.29 dB/year). RNFL thickness reduced by −4.21 ± 0.25 µm/year from 1st month of follow-up. Eyes with an absence of initial VF improvement (β = 0.64; 0.30-0.98), RNFL thinning (β = 0.15; 0.08-0.23), increasing intraocular pressure (IOP; β = −0.11; −0.18 to −0.03) and severe glaucoma (β = −10.82; −13.61 to −8.02) were associated with VF deterioration. Eyes with VF deterioration (β = 0.19; 0.08-0.29), increasing IOP (β = −0.09; −0.17 to −0.01), and moderate (β = −6.33; −12.17 to −0.49) or severe glaucoma (β = −19.58; −24.63 to −14.52) were associated with RNFL thinning. Changes in RNFL structure and function occur over a 1-year follow-up period after trabeculectomy.Early VF improvement is more likely to occur in patients with mild/moderate glaucoma, whereas those with severe glaucoma show greater decline over one year. Our findings indicate that progression is observable using OCT, even in late-stage glaucoma.Clinically, reduction of intraocular pressure (IOP) remains the only proven treatment for glaucoma 1-3 . Landmark glaucoma randomized clinical trials have confirmed the value of lowering IOP in delaying visual field (VF) progression 1-5 . Interestingly, recent studies 6-8 have reported that the surgical lowering of IOP in glaucoma can result in the improvement of VF, which lends support to the preliminary data reported by Katz and Spaeth, who demonstrated reversal of structural change and field loss in newly diagnosed patients after commencement of treatment 9,10 .Apart from functional changes, others have examined structural changes after trabeculectomy and their potential association with functional changes. The association between structural glaucomatous damage with VF decline after trabeculectomy is complex. The MoreFlow Medical Research Council 5-Fluorouracil (5-FU) study reported that out of 250 eyes, 20 eyes showed structural progression, 35 eyes showed VF progression, and 15 eyes showed both over a five years period 11 . In the Collaborative Initial Glaucoma Treatment Study (CIGTS), VF worsening was significantly associated with enlargement of the optic cup, but reversal of cupping was not associated with improvement of the VF 12 . Other studies reported an early increase in retinal nerve fiber layer (RNFL) thickness after trabeculectomy, but did not investigate the relation with VF changes [13][14][15][16][17] . Also, these studies have used the older time-domain optical coherence tomography (OCT) 14,16 , stereoscopic optic disc photographs 12,15 scanning laser polarimetry 17 , or Heidelberg Retina Tom...

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Section: Discussionsupporting

confidence: 93%

One year structural and functional glaucoma progression after trabeculectomy

Chua

Kadziauskiene

Wong

et al. 2020

Sci Rep

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“…1 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). 1 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.…”

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confidence: 59%

“…The interpretation of this finding is discussed in our article. 1 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.…”

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confidence: 86%

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2019

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“…Therefore, a more frequent trend-based progression in GCIPL than RNFL implies GCIPL may have a tendency for diffuse-type progression compared with RNFL, which may tend to show localized-type progression. 2 In the study from Lavinsky et al, 1 when eventbased OCT GPA analysis was used, more frequent progression was found in RNFL (31 eyes) compared with GCIPL (10 eyes), which is in contrast with the trend-based analysis. Thus, these results may be interpreted as, "In advanced stages of glaucoma, trend-based progression was more frequently found in GCIPL and ONH than in RNFL and event-based progression was more commonly found in RNFL than in GCIPL."…”

mentioning

confidence: 97%

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)

Hwang

2019

Ophthalmology

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we hope future studies in larger patient pools followed for a sufficient time to observe corneal reinnervation will be performed soon. Regarding duration of disease/corneal denervation, demographic factors and underlying causes, we could not find any risk factor that could be responsible for a lower efficacy of the treatment and based on the results of this trial we anticipate that rhNGF eye drops could be beneficial in all patients with moderate-severe NK. Therefore, we fully agree that the REPARO trial represents a giant leap forward in the field of NK and take this chance to anticipate that, since this paper was first submitted, a confirmatory study (NCT02227147) has already been performed successfully in the United States. Both the European Medicine Agency and the Food and Drug Administration have now granted marketing authorization for rhNGF (cenegermin) eye drops in NK based on the results of these studies. The product is already available in Europe and should be available shortly in the United States.

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Can Macula and Optic Nerve Head Parameters Detect Glaucoma Progression in Eyes with Advanced Circumpapillary Retinal Nerve Fiber Layer Damage?

Abstract: Macula GCIPL and ONH parameters may be useful in tracking progression in patients with advanced glaucoma.

Cited by 59 publications

References 27 publications

One year structural and functional glaucoma progression after trabeculectomy

One year structural and functional glaucoma progression after trabeculectomy

Reply

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)

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