How to detect progression in glaucoma

Moraes

2017

Journal of Glaucoma

Purpose To test the hypothesis that the relationship between baseline visual field damage and the rate of progression depends upon the use of logarithmic (dB) versus linear (1/Lambert) scale. Methods 60 eyes (60 patients) with treated, established glaucoma and at least 5 reliable 24-2 visual fields were included. Baseline visual field mean deviation (MD) in dB was transformed to 1/Lambert using standard equation. Mixed effects linear regression was used to calculate the slopes (MD rates of progression over time) with linear and non-linear scales. We tested relationship between baseline MD and MD slopes for each scale of measure. Results In dB scale, worse baseline visual field loss was associated with faster MD slopes (P=0.037), while the opposite effect was seen in 1/Lambert (P=0.001). For a similar rate of progression in dB/year, eyes with mild visual field damage lost more linear sensitivity over a given period of time than those with more severe baseline damage. Conclusions There is a significant relationship between baseline visual field severity and rates of MD progression, although the direction of this association depends on the scale sensitivity is measured. The definition of fast versus slow visual field progression should be revised and take into account that sensitivity in linear scales show a better correlation with structural loss than when conventionally measured in non-linear scale.

Section: Introductionmentioning

confidence: 99%

Measuring Rates of Visual Field Progression in Linear Versus Nonlinear Scales: Implications for Understanding the Relationship Between Baseline Damage and Target Rates of Glaucoma Progression

Moraes

2017

Journal of Glaucoma

“…They reported that higher baseline thickness had higher rates of decline. Vianna et al 29 demonstrated that patients with treated glaucoma had faster, but not statistically different, rates of deterioration of RNFL thickness compared with controls, by −0.40 µm/year (p=0.11). The RNFL attenuation in both progressors and non-progressors was higher than that reported as age-related in normal subjects.…”

Section: Discussionmentioning

confidence: 97%

5-year disease progression of patients across the glaucoma spectrum assessed by structural and functional tools

et al. 2017

BackgroundAssessment of spectral-domain optical coherence tomography (SD-OCT) compared with visual fields, to detect progression across the glaucoma spectrum.MethodsIn this study, adult glaucoma suspects and patients, with baseline retinal nerve fibre layer (RNFL) thickness on SD-OCT and reliable visual field (VF) tests on Humphrey Field Analyser (HFA) prior to March 2010, were recruited. Functional and structural progression over at least 5 years was compared using Glaucoma Progression Analysis (GPA) and VF index (VFI) on HFA and Guided Progression Analysis (GPA-OCT) on SD-OCT, respectively. Agreement of progression detection between the two modalities was computed using κ statistics.Results122 subjects (63 glaucoma suspects; 59 glaucoma patients) were enrolled. Of 18 suspects who progressed to glaucoma, 13 showed progression by GPA-OCT, 4 by GPA, 7 by VFI and 2 were concordant. In the 14 glaucoma patients who progressed, GPA-OCT detected progression in 6, GPA in five and VFI in six. GPA-OCT had poor agreement with GPA in glaucoma suspects (Kappa 0.15; p=0.13) and patients (Kappa 0.10; p=0.45). VFI had better agreement with GPA-OCT in glaucoma suspects (Kappa 0.34; p=0.01) than glaucoma patients (Kappa 0.12; p=0.36). Progressors by VF in both groups had similar percentage change from baseline RNFL thickness (−9.9% vs −8.6% p=0.46), even though the absolute change was significantly greater in suspects(−8.75µ vs−6.4µ p=0.03).ConclusionStructural change appears to be more useful to detect progression in glaucoma suspects, while functional change is a better indicator as the disease progresses. Percentage change from baseline RNFL thickness was a better measure than absolute change in RNFL.

Journal of Ophthalmology

“…Determining the rate of VF progression is a new standard in glaucoma care and the general recommendation is to perform six VF examinations in the first two years [74, 84]. However, taking into consideration the lack of resources and the burden on patients (time of work, travelling, etc.)…”

Section: Treatment Goalsmentioning

confidence: 99%

Medical Management of Glaucoma in the 21st Century from a Canadian Perspective

Harasymowycz

Birt

Gooi

et al. 2016

100

Glaucoma is a medical term describing a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and retinal nerve fibre layer and resulting in changes in the optic nerve head. Glaucoma is a leading cause of irreversible vision loss worldwide. With the aging population it is expected that the prevalence of glaucoma will continue to increase. Despite recent advances in imaging and visual field testing techniques that allow establishment of earlier diagnosis and treatment initiation, significant numbers of glaucoma patients are undiagnosed and present late in the course of their disease. This can lead to irreversible vision loss, reduced quality of life, and a higher socioeconomic burden. Selection of therapeutic approaches for glaucoma should be based on careful ocular examination, patient medical history, presence of comorbidities, and awareness of concomitant systemic therapies. Therapy should also be individualized to patients' needs and preferences. Recent developments in this therapeutic field require revisiting treatment algorithms and integration of traditional and novel approaches in order to ensure optimal visual outcomes. This article provides an overview of recent developments and practice trends in the medical management of glaucoma in Canada. A discussion of the surgical management is beyond the scope of this paper.