Detection of progression of glaucomatous retinal nerve fibre layer defects using optical coherence tomography‐guided progression analysis

Abstract

Purpose: The aim was to investigate the agreement for detection of progression of glaucomatous retinal nerve fibre layer defects (RNFLD) between optical coherence tomographyguided progression analysis (OCT GPA) and conventional red-free fundus photography. Methods: Four hundred and fifteen glaucomatous eyes that underwent at least four serial red-free photographic and OCT examinations were included in the study. Based on the inspection of the red-free fundus photographs and GPA maps, RNFLD progression was defined as the development of a new defect, widening or deepening of a pre-existing RNFLD in red-free fundus photography (photographic progression) or 'Likely Loss' on a GPA map (GPA progression). The agreement of photographic and OCT GPA progression and the factors influencing it, including refractive error, severity of glaucoma (mean deviation of the visual field), type of RNFLD (localised versus diffuse), width of the baseline RNFLD, type of RNFLD progression (new defect, widening, deepening) and location of RNFLD progression (clock-hour sector) were assessed. Results: Among the 415 eyes, 82 (19.8 per cent) showed photographic or GPA progression. Among the 82 eyes with progression, progression was detected only in red-free fundus photography in nine (11.0 per cent) eyes and only in GPA in 32 (39.0 per cent) eyes. In 41 eyes (50.0 per cent), progression was detected with both methods. Detection of RNFLD progression only in GPA was associated with a higher myopia, diffuse RNFLD, deepening of the RNFLD and RNFLD progression at the 6, 9 and 12 o'clock positions (p < 0.05). Conclusions: OCT GPA may be a useful supplement to conventional red-free fundus photography for detecting RNFLD progression.

Glaucomatous progression in the retinal nerve fibre and retinal ganglion cell‐inner plexiform layers determined using optical coherence tomography‐guided progression analysis

“…This study was performed as a succeeding study to our previous report in which glaucomatous RNFL defect progression was investigated using OCT‐GPA; thus, the present study protocol was in line with that of the previous study . This study included more eyes with longer follow‐up compared to our previous report . The purpose of the previous study was to compare the ability of red‐free fundus photography and OCT‐GPA to detect RNFL defect progression.…”

“…In brief, each subject underwent a complete ophthalmic examination that included visual acuity and refractive error assessments using a model RK‐5 autorefractor‐keratometer (Canon, Tokyo, Japan), intraocular pressure (IOP) measurements using a Goldmann applanation tonometer, anterior segment examination using slitlamp biomicroscopy, ONH evaluation and fundus examination using a 90 dioptre lens, gonioscopy, 24‐2 Swedish Interactive Threshold Algorithm standard automated visual field test using a Humphrey Visual Field Analyzer (Carl Zeiss Meditec, Jena, Germany), red‐free fundus photography using a Kowa Nonmyd 7 fundus camera (Kowa, Tokyo, Japan), and circumpapillary RNFL and macular GCIPL thickness measurements using Cirrus HD‐OCT …”

“…Eyes that underwent ocular surgery or laser treatment during the follow‐up period were not included. Eyes with other retinal or neurologic disorders, which could affect RNFL/GCIPL thickness measurement or visual field test results, were excluded …”

“…Cirrus‐HD OCT presents RNFL and GCIPL thickness changes by using the GPA software as previously described (Figures and ) . GPA analyses RNFL/GCIPL thickness change compared with the baseline test results, and if the amount of change exceeds the test–retest variability of the system, the change is presented as ‘Possible Loss (presented as a yellow colour code)’ or ‘Likely Loss (presented as a red colour code).’ GPA provides three RNFL progression parameters, including RNFL ‘thickness map progression’ (when at least 20 adjacent pixels in any pixel cluster are affected), RNFL ‘thickness profiles progression’ (when at least 14 adjacent profile points are affected), and ‘average thickness progression’ (when the slope of the average/superior/inferior RNFL thickness change is significant).…”

“…Several studies have investigated the usefulness of OCT‐GPA for assessing glaucomatous RNFL defect progression . For instance, previous studies reported that OCT‐GPA may detect RNFL defect progression that was not evident with a conventional method, such as red‐free fundus photography, especially when the RNFL defect is diffuse . However, to date, little is known about the clinical implication of OCT‐GPA in evaluating macular GCIPL progression .…”