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Which OCT parameters can best predict visual field progression in glaucoma?

Eye volume 37, pages 3523–3525 (2023)Cite this article

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Primary open-angle glaucoma (POAG) is characterized by progressive loss of retinal ganglion cells (RGC), resulting in visual field (VF) loss. Although standard automated perimetry can assess visual function, 25 to 35% of RGC must be lost prior to significant VF abnormalities [1]. Additionally, fixation losses, false positive, and false negative results on VF tests can cloud judgment of glaucoma severity [2]. Thus, accurate measurement of RGC structural changes is critical to predict VF changes. Optical coherence tomography (OCT) provides non-invasive imaging to assess structural glaucomatous damage and can guide management in patients. The retinal nerve fiber layer (RNFL) consists of RGC axons, and peripapillary RNFL (pRNFL) thinning has been strongly associated with VF progression in patients (HR 8.44; 95% CI: 3.30–21.61) based on Early Manifest Glaucoma Trial criteria [3, 4]. However, drawbacks persist with RNFL measurements. For example, monitoring of advanced glaucoma may be limited by a floor effect [5, 6], and high myopia can cause anatomical alterations such as peripapillary atrophy and optic nerve head tilt resulting in errors from OCT segmentation algorithms [7]. Here, we will discuss the performance of macular OCT and neuroretinal rim width, in predicting VF changes in glaucoma patients when compared to RNFL thickness (RNFLT) (Table 1).

Table 1 Using optical coherence tomography parameters to monitor visual field progression in glaucoma.
Full size table

Macular ganglion cell complex thickness (mGCCT) may serve as a more accurate predictor for VF loss for two reasons. First, the macular OCT measures structural changes that topographically matches VF testing locations. Specifically, unlike the RNFLT that only monitors RGC axonal damage, mGCCT represents the sum of the thickness of RNFL, cell bodies and dendrites in the ganglion cell layer (GCL) and inner plexiform layer (IPL), respectively [1, 8]. Additionally, approximately 50% of the RGCs are concentrated in the macula [9]. Second, RNFLT is more sensitive to decentration error and the floor effects. RNFLT is inversely related to the radial distance from the center of the optic disc and can be affected by anatomic variations. Meanwhile, GCCT varies slowly outside of the parafoveal region and has a larger sampling circle (6 mm) compared to NFLT (3.4 mm) [10]. Evidently, several studies suggested the superior performance of the mGCCT comparing to the RNFLT for VF prediction. For instance, Anraku et al. found that inferior mGCCT, but not RNFLT, was the only prognostic factor for VF loss in POAG patients via a multivariate analysis (OR: 0.894; 95% CI: 0.825–0.970; p = 0.007) [11]. Patients without advanced glaucoma (MD > −12 dB) were divided into groups based on VF loss rates: fast progressors (mean deviation (MD) slope < −0.4 dB/year) and slow progressors (MD slope ≥ −0.4 dB/year). Baseline measurement of inferior hemifield mGCCT was significantly lower in fast progressors compared to slow progressors (68.0 ± 6.6 μm; 78.2 ± 11.6 μm; p = 0.002). Additionally, Zhang et al. showed that baseline mGCCT focal loss volume (FLV) but not pRNFLT FLV was the most accurate structural predictor of VF progression in a multivariate model (HR 1.36; p < 0.0001) [10].

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Authors and Affiliations

  1. Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA

    Abhishek Sethi, Joelle A. Hallak & Thasarat Sutabutr Vajaranant

  2. Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA

    Homa Rashidisabet

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AS and HR contributed to literature review and preparation of the manuscript. JAH and TSV contributed to editing and revising the manuscript.

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Correspondence to Thasarat Sutabutr Vajaranant.

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Sethi, A., Rashidisabet, H., Hallak, J.A. et al. Which OCT parameters can best predict visual field progression in glaucoma?. Eye 37, 3523–3525 (2023). https://doi.org/10.1038/s41433-023-02547-3

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