Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, PRC.
Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, PRC.
Ophthalmology. 2013 Dec;120(12):2485-2492. doi: 10.1016/j.ophtha.2013.07.021. Epub 2013 Aug 30.
To investigate the impact of age-related change of macular and circumpapillary retinal nerve fiber layer (RNFL) measurements on evaluation of glaucoma progression.
Prospective, longitudinal study.
A total of 150 eyes of 90 patients with glaucoma and 72 eyes of 40 normal individuals.
Both eyes were imaged by the Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA; optic nerve head and macular scans were taken every 4 months for a mean of 45.8 months (range, 35.4-60.6 months). The mean age-related rates of change of macular (including the ganglion cell and inner plexiform layer [GCIPL], inner retina [IR], outer retina [OR], and total macular thicknesses) and circumpapillary RNFL measurements were estimated with linear mixed models in the normal group. Macular and RNFL progression were then evaluated in individual eyes in the glaucoma group, with trend analysis before and after accounting for age-related change using the lower 95% confidence intervals (CIs) of the mean age-related rates of change as cutoffs. The survival probability was evaluated with the Kaplan-Meier estimator, and the agreement of progression detection among the structural parameters was calculated with Kappa statistics.
Detection of glaucoma progression and survival probability of macular and RNFL parameters.
Before accounting for age-related change, 50.0% (75 eyes) showed progression by the GCIPL thickness, 50.0% (75 eyes) showed progression by the IR thickness, 30.0% (45 eyes) showed progression by the total macular thickness, 27.3% (41 eyes) showed progression by the circumpapillary RNFL thickness, and 10.0% (15 eyes) showed progression by the OR thickness. The survival probability of GCIPL and IR thicknesses were significantly worse compared with circumpapillary RNFL thickness (P ≤ 0.001). After accounting for age-related change, the proportions decreased to 14.7%, 20.0%, 16.0%, 26.7%, and 1.3%, respectively, with the circumpapillary RNFL thickness demonstrating the worst survival probability. The agreement of progression detection between RNFL and macular measurements was poor with (kappa range, -0.055 to 0.185) or without (kappa range, -0.046 to 0.173) taking age-related change into consideration.
Age-related change of macular and circumpapillary RNFL measurements can be detected in normal eyes and can affect the analysis of glaucoma progression. The impact is more substantial in analyzing macular progression than circumpapillary RNFL progression.
探讨年龄相关性黄斑和环周视网膜神经纤维层（RNFL）测量变化对青光眼进展评估的影响。
前瞻性、纵向研究。
共纳入 90 例青光眼患者的 150 只眼和 40 例正常对照者的 72 只眼。
采用 Cirrus HD-OCT（德国卡尔蔡司公司）对所有眼进行成像（视神经头和黄斑扫描，平均随访 45.8 个月（范围 35.4-60.6 个月），每 4 个月扫描一次。使用线性混合模型估计正常组黄斑（包括节细胞和内丛状层[GCIPL]、内视网膜[IR]、外视网膜[OR]和总黄斑厚度）和环周 RNFL 测量的年龄相关性变化率的平均值。然后，在青光眼组中对个体眼进行黄斑和 RNFL 进展评估，在考虑年龄相关性变化之前和之后，使用平均值的 95%置信区间（CI）作为截止值进行趋势分析。使用 Kaplan-Meier 估计器评估生存概率，使用 Kappa 统计分析评估结构参数之间的进展检测一致性。
青光眼进展的检测和黄斑及 RNFL 参数的生存概率。
在未考虑年龄相关性变化之前，GCIPL 厚度的 50.0%（75 只眼）、IR 厚度的 50.0%（75 只眼）、总黄斑厚度的 30.0%（45 只眼）、环周 RNFL 厚度的 27.3%（41 只眼）和 OR 厚度的 10.0%（15 只眼）显示出进展。GCIPL 和 IR 厚度的生存概率明显差于环周 RNFL 厚度（P≤0.001）。在考虑年龄相关性变化之后，比例分别下降至 14.7%、20.0%、16.0%、26.7%和 1.3%，其中环周 RNFL 厚度的生存概率最差。考虑或不考虑年龄相关性变化，RNFL 和黄斑测量之间的进展检测一致性均较差（kappa 范围，-0.055 至 0.185）。
正常眼可检测到黄斑和环周 RNFL 测量的年龄相关性变化，这可能会影响青光眼进展的分析。这种影响在分析黄斑进展时比分析环周 RNFL 进展时更为显著。
