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Mohammadi M, Su E, Mohammadzadeh V, Besharati S, Martinyan A, Coleman AL, Law SK, Caprioli J, Weiss RE, Nouri-Mahdavi K. Comparison of Retinal Nerve Fiber Layer and Ganglion Cell Complex Rates of Change in Patients With Moderate to Advanced Glaucoma. Am J Ophthalmol 2024; 268:190-198. [PMID: 39111519 DOI: 10.1016/j.ajo.2024.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/16/2024] [Accepted: 07/24/2024] [Indexed: 09/01/2024]
Abstract
PURPOSE To compare ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) rates of change (RoC) in eyes with central or moderate to advanced glaucoma. DESIGN Prospective cohort study. PARTICIPANTS A total of 918 matched macular and RNFL OCT scan pairs from 109 eyes (109 patients) enrolled in the Advanced Glaucoma Progression Study with ≥2 years of follow-up and ≥4 OCT scans. METHODS We exported GCC and RNFL thickness measurements in 49 central macular superpixels and 12 RNFL clock-hour sectors, respectively. We applied our latest Bayesian hierarchical longitudinal model to estimate population and subject-specific baseline thickness (intercepts) and rates of change (RoC) in macular superpixels and RNFL sectors. Global RNFL and GCC RoC were analyzed in a single bivariate longitudinal model to properly compare them accounting for the correlation between their RoC. MAIN OUTCOME MEASURES Proportion of significant negative (deteriorating) and positive (improving) RoC expressed in μm/year. Standardized RoC were calculated by dividing RoC by the corresponding population SD. Analyses were repeated in eyes with visual field mean deviation (MD) ≤-6 and > -6 dB. RESULTS Average (SD) 24-2 visual field MD and follow-up length were -8.6 (6.3) dB and 4.2 (0.5) years, respectively. Global RNFL RoC (-0.70 µm/year) were faster than GCC (-0.44 µm/year) (P < .001); corresponding normalized RoC were not significantly different (P = .052). In bivariate analysis, patients with a significant negative global RNFL RoC (n = 63, 57%) or GCC (n = 56, 51%) frequently did so for both outcomes (n = 49, 45%). The average proportion of significantly decreasing RNFL sectors within an eye was 30.7% in eyes with MD > -6 dB compared to 20.5% in those with MD ≤ -6 dB (P = .014); the proportions for GCC superpixels were 21.1% versus 18.7%, respectively (P = .63). CONCLUSIONS Both GCC and RNFL measures can detect structural progression in glaucoma patients with central damage or moderate to advanced glaucoma. The clinical utility of RNFL imaging decreases with worsening severity of glaucoma.
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Affiliation(s)
- Massood Mohammadi
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Erica Su
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Vahid Mohammadzadeh
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Sajad Besharati
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Arthur Martinyan
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Anne L Coleman
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Simon K Law
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Joseph Caprioli
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles (R.E.W.), Los Angeles, California, USA
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA.
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Tomita R, Rawlyk B, Sharpe GP, Hutchison DM, Shuba LM, Nicolela MT, Chauhan BC. Progressive Changes in the Neuroretinal Rim and Retinal Nerve Fiber Layer in Glaucoma: Impact of Baseline Values and Floor Effects. Ophthalmology 2024; 131:700-707. [PMID: 38176444 DOI: 10.1016/j.ophtha.2023.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE To determine whether more severe baseline damage impedes measurement of minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness (RNFLT) change in glaucoma patients because of a floor effect. DESIGN Prospective, longitudinal cohort study in a hospital-based setting. PARTICIPANTS The study included patients with open-angle glaucoma and healthy control subjects. Participants had at least 5 years of follow-up with OCT every 6 months. METHODS Baseline global and sectorial MRW and RNFLT values were classified as within normal limits, borderline, or outside normal limits based on reference normative values. Regression analysis was used to determine the magnitude and significance of MRW and RNFLT change. Additionally, the follow-up period for each participant was divided into 2 equal halves (first and second periods) to determine whether there was attenuation of MRW and RNFLT change with follow-up time. MAIN OUTCOME MEASURES Rates of global and sectoral MRW and RNFLT changes (slopes). RESULTS A total of 97 patients with glaucoma (median age, 70.3 years) and 42 healthy subjects (median age, 64.8 years) were followed for a median of 6.9 years and 7.0 years, respectively. The median mean deviation of the visual field in glaucoma patients was -4.30 decibels (dB) (interquartile range, -7.81 to -2.06 dB; range, -20.68 to 1.37 dB). Statistically significant changes in global and sectoral MRW and RNFLT were detected across all baseline classifications; however, there was a tendency for less change with increasing baseline damage. In glaucoma patients, RNFLT slopes, but not MRW slopes, were significantly more positive (less change) in the second period compared with the first. There were also no differences in MRW or RNFLT slopes in the first and second periods in healthy subjects. CONCLUSIONS Significant MRW and RNFLT changes were detected at all levels of baseline damage. However, an attenuation in the rate of RNFLT change compared with MRW indicates an earlier floor effect in RNFLT measurements globally and in equivalent sectors. Because the axonal component of these measurements should be equivalent, our results suggest important differences in tissue remodeling at the level of the optic nerve head and peripapillary retina. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Ryo Tomita
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brooklyn Rawlyk
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada; University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Glen P Sharpe
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Donna M Hutchison
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lesya M Shuba
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marcelo T Nicolela
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Balwantray C Chauhan
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.
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Hui Z, Guo X, Bulloch G, Yuan M, Xiong K, Zhang S, Chen Y, Li Y, Liao H, Huang W, Zhu Z, Wang W. Rates of choroidal loss and ganglion cell-inner plexiform layer thinning in type 2 diabetes mellitus and healthy individuals: a 2-year prospective study. Br J Ophthalmol 2023; 108:84-90. [PMID: 36385002 DOI: 10.1136/bjo-2022-321603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
AIMS To investigate longitudinal choroid and ganglion cell-inner plexiform layer (GCIPL) changes in type 2 diabetes mellitus (T2DM) patients and healthy populations across 2 years. METHODS This prospective cohort study included T2DM patients and healthy controls. T2DM patients were divided into mild non-proliferative diabetic retinopathy (NPDR) or non-DR (NDR) groups. Macular choroidal and GCIPL thickness was measured using swept-source optical coherence tomography at baseline and follow-up after 2 years. A linear-mixed effect model compared rates of change in choroidal and GCIPL thicknesses between the three groups. RESULTS 895 T2DM patients (770 in the NDR group and 125 in the NPDR group) and 847 healthy controls were included. Following 2 years, choroidal thinning occurred at a rate of -7.7±9.2 µm/year, -8.1±8.7 µm/year and -5.2±8.1 µm/year in NDR, NPDR and control groups, respectively (p<0.001). GCIPL loss occurred quickest in NPDR patients (-0.97±0.97 µm/year), followed by NDR (-0.91±0.89 µm/year) and the control group (-0.04±0.55 µm/year) (p<0.001). Following multivariate adjustment, choroidal thinning was -2.04 µm/year (95% CI: -4.05 to -0.03; p=0.047) and -1.95 µm/year (95% CI: -3.14 to -0.75; p=0.001) faster in NPDR and NDR groups than in the control group, respectively, and GCIPL thinning was -1.02 µm/year (95% CI: -1.19 to -0.84; p<0.001) and -0.88 µm/year (95% CI: -0.98 to -0.78; p<0.001) faster in the NPDR and NDR groups than in the control group, respectively. CONCLUSION Progressive choroidal and GCIPL thinning occurs in healthy individuals and T2DM patients; however, T2DM undergoes accelerated choroidal and GCIPL loss in NPDR patients.
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Affiliation(s)
- Ziwen Hui
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
- Zhongs School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Xiao Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Gabriella Bulloch
- Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia
| | - Meng Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Kun Xiong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Shiran Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | | | - Yuting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Huan Liao
- University of Melbourne, Melbourne, Victoria, Australia
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Zhuoting Zhu
- Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
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Konstantakopoulou E, Kastner A, Gazzard G, Jayaram H. Validation of the RCOphth and UKEGS glaucoma risk stratification tool 'GLAUC-STRAT-fast'. Br J Ophthalmol 2023; 107:1258-1263. [PMID: 35534178 DOI: 10.1136/bjophthalmol-2021-320968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/11/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS The aim of this study was to validate the Glaucoma Risk Stratification Tool (GLAUC-STRAT-fast) currently recommended by the Royal College of Ophthalmologists for the risk stratification of patients with glaucoma in the UK National Health Service Hospital Eye Service. METHODS GLAUC-STRAT fast was applied to the LiGHT trial participants by risk-stratifying the worse eye of each patient at baseline and after 3 years of treatment. Metrics of disease severity or treatment intensity used for the validation were: increased number of monitoring visits or treatment escalations; needing a trabeculectomy; a reduction of >2 dB in visual field mean deviation (VF MD) during the monitoring period; identification of rapid VF loss on total (TD) and/or pattern deviation (PD). The proportion of eyes within each baseline stratum for each of the above markers was compared against the other strata, using a χ2 test for proportions. RESULTS There was an association between the baseline stratification and the number of treatment escalations needed to maintain the eye-specific target intraocular pressure (p=0.001), the number of visits needed throughout the 3-year follow-up period (p=0.001), the need for trabeculectomy (p<0.001) and absolute loss of MD over the course of the monitoring period (p<0.001). The rate of VF progression was not associated with baseline risk stratification for TD or PD progression (p≥0.007, with Bonferroni correction). CONCLUSION The GLAUC-STRAT fast tool is a useful tool for risk stratifying eyes with ocular hypertension or open angle glaucoma. Further research is needed to confirm and validate its applicability to more advanced glaucomas and generalisability to clinical use. TRIAL REGISTRATION NUMBER The LiGHT trial is registered at controlled-trials.com (ISRCTN32038223).
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Affiliation(s)
- Evgenia Konstantakopoulou
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Optics & Optometry, University of West Attica, Egaleo, Greece
| | - Alan Kastner
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gus Gazzard
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Hari Jayaram
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
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