Predicting Progression in Glaucoma Suspects With Longitudinal Estimates of Retinal Ganglion Cell Counts

Abstract

PURPOSE. We evaluated the ability of baseline and longitudinal estimates of retinal ganglion cell (RGC) counts in predicting progression in eyes suspected of having glaucoma.METHODS. The study included 288 glaucoma suspect eyes of 288 patients followed for an average of 3.8 6 1.0 years. Participants had normal standard automated perimetry (SAP) at baseline. Retinal nerve fiber layer thickness assessment was performed with optical coherence tomography (OCT). Progression was defined as development of repeatable abnormal SAP or glaucomatous progressive optic disc changes. Estimates of RGC counts were obtained by combining data from SAP and OCT according to a previously described method. Joint longitudinal survival models were used to evaluate the ability of baseline and rates of change in estimated RGC counts for predicting progression over time, adjusting for confounding variables. RESULTS.A total of 48 eyes (17%) showed progression during follow-up. The mean rate of change in estimated RGC counts was À18,987 cells/y in progressors versus À8,808 cells/y for nonprogressors (P < 0.001). Baseline RGC counts and slopes of RGC loss were significantly predictive of progression, with HRs of 1.56 per 100,000 cells lower (95% confidence interval [CI], 1.18-2.08; P ¼ 0.002) and 2.68 per 10,000 cells/y faster loss (95% CI, 1.22-5.90; P ¼ 0.014), respectively. The longitudinal model including estimates of RGC counts performed significantly better than models including only structural or functional indexes separately.CONCLUSIONS. Baseline and longitudinal estimates of RGC counts may be helpful in predicting progression and performed significantly better than conventional approaches for risk stratification of glaucoma suspects.

The Prevalence and the Incidence of Diagnosed Open-Angle Glaucoma and Diagnosed Angle-Closure Glaucoma: Changes From 2001 to 2010

“…The increasing trend in diagnosed OAG incidence might be related to the ubiquity of advanced diagnostic tools (eg, optical coherence tomography), physician awareness, the high prevalence of myopia, and the accessibility of health care in Taiwan. 3,9,10,[18][19][20] Optical coherence tomography provides for the analysis of retinal nerve fiber layer and retinal ganglion cells, allowing ophthalmologists to diagnose ocular diseases early. 18,20 Moreover, myopia is a risk factor for OAG.…”

“…3,9,10,[18][19][20] Optical coherence tomography provides for the analysis of retinal nerve fiber layer and retinal ganglion cells, allowing ophthalmologists to diagnose ocular diseases early. 18,20 Moreover, myopia is a risk factor for OAG. 3,21 According to the Taiwan National Health Interview Survey, the overall prevalence of myopia in Taiwan was 46.7% in 2005.…”

Biomarkers and surrogate endpoints in glaucoma clinical trials

“…In several studies, changes in neuroretinal rim area, as measured by CSLO, were shown to predict future visual field losses 35–40. More recently, longitudinal studies using spectral domain OCT have shown that changes in RNFL thickness were also highly predictive of future functional losses in glaucoma suspects 41 42. However, in order to show that structural measurements can be used as reliable surrogate endpoints, one has to also demonstrate that the effect of treatment on changes in structure is a reliable predictor of the effect of treatment on changes in function.…”

One Year of Glaucoma Research in Review

“…In order to assess the utility of RGC counts in predicting progression, Meira-Freitas and colleagues 27 followed 288 eyes of 288 patients suspected of having glaucoma for a total of 3.8 ± 1.0 years. Of the 48 eyes that showed progression during the follow-up period, the mean rate of change in estimated RGC counts was −18,987 cells/y in progressors and −8808 cells/y in nonprogressors ( P < 0.001).…”

“…In addition, the longitudinal model including estimates of RGC counts performed significantly better than models including only structural or functional indexes. 27 …”