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Event-based analysis of visual field change can miss fast glaucoma progression detected by a combined structure and function index

  • Glaucoma
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the relationship between progression assessed by the visual field guided progression analysis (GPA) and rates of structural and functional change in glaucoma eyes.

Methods

This was a longitudinal observational study of 135 eyes of 97 patients with glaucoma followed for an average of 3.5 ± 0.9 years. All patients had standard automated perimetry (SAP) and retinal nerve fiber layer (RNFL) analysis with spectral domain optical coherence tomography (SDOCT), with an average of 6.8 ± 2.3 visits. A control group of healthy eyes followed longitudinally was used to estimate age-related change. Visual field progression was assessed using the Humphrey Field Analyzer GPA. Estimates of retinal ganglion cell counts from SAP and SDOCT were used to obtain a combined index of glaucomatous damage (RGC index) according to a previously described algorithm. Progression by SDOCT and the retinal ganglion cell (RGC) index were defined as statistically significant (P < 0.05) slopes of change that were also faster than age-related change estimated from healthy eyes.

Results

From the 135 eyes, 15 (11%) progressed by GPA, 21 (16%) progressed by SDOCT, and 31 (23%) progressed by the RGC index. Twenty-one eyes showed progression by the RGC index that was missed by the GPA. These eyes had an average rate of change in estimated RGC counts of − 28,910 cells/year, ranging from two to nine times faster than expected age-related losses.

Conclusion

Many glaucomatous eyes that are not found to be progressing by GPA may actually have fast rates of change as detected by a combined index of structure and function.

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Funding

National Institutes of Health/National Eye Institute provided financial support in part in the form of grant EY021818 (F.A.M.); Natural Science Foundation of Heilongjiang Province for Returned Scholars, China, provided financial support in the form of grant no. LC2012C21 (C.Z.); Innovation research special fund of the Science and Technology of Harbin of Heilong Jiang Province, China, provided financial support in the form of grant no. 2011RFLYS029 (C.Z.). The sponsors had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Visual Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University School of Medicine, 2310 Erwin Rd, Durham, NC, 27710, USA

    Chunwei Zhang, Andrew J. Tatham, Fábio B. Daga, Alessandro A. Jammal & Felipe A. Medeiros

  2. Department of Ophthalmology, the First Affiliated Hospital, Harbin Medical University, Harbin, China

    Chunwei Zhang

  3. Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, UK

    Andrew J. Tatham

Authors
  1. Chunwei Zhang
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  2. Andrew J. Tatham
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  3. Fábio B. Daga
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  4. Alessandro A. Jammal
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  5. Felipe A. Medeiros
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Corresponding author

Correspondence to Felipe A. Medeiros.

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Conflict of interest

The authors have made the following disclosures: C.Z.—none; A.J.T.—research support from Heidelberg Engineering; F.B.D.—none; A.A.J.—none; F.A.M.—F: Alcon Laboratories, Bausch & Lomb, Carl Zeiss Meditec, Heidelberg Engineering, Merck, Allergan, Sensimed, Topcon, Reichert, National Eye Institute, R: Alcon Laboratories, Allergan, Carl Zeiss Meditec, Reichert, C: Allergan, Carl Zeiss Meditec, Novartis.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board and human subjects committee of the Duke University and University of California San Diego (UCSD) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Zhang, C., Tatham, A.J., Daga, F.B. et al. Event-based analysis of visual field change can miss fast glaucoma progression detected by a combined structure and function index. Graefes Arch Clin Exp Ophthalmol 256, 1227–1234 (2018). https://doi.org/10.1007/s00417-018-3963-3

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  • DOI: https://doi.org/10.1007/s00417-018-3963-3

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