Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Alabama, AL.
Computational Optometry, Atarfe, Spain.
J Glaucoma. 2021 Sep 1;30(9):769-775. doi: 10.1097/IJG.0000000000001843.
Glaucoma progression was more frequently identified by assessing retinal fiber layer thickness than by monitoring visual field (VF) loss for different baseline classifications in primary open-angle glaucoma.
The aim was to compare the detection of glaucoma progression by retinal nerve fiber layer thickness (RNFLT) and VF assessments for different baseline classifications of primary open-angle glaucoma.
This study included 194 eyes from 194 patients with a minimum of 9 follow-up visits selected from the Diagnostic Innovation in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES). Each eye was classified according to baseline clinical signs: ocular hypertension (n=39), glaucomatous optic neuropathy only (n=60), glaucomatous visual field loss only (GVF, n=39) and definite glaucoma (concurrent optic disc and VF defect, n=56). We assessed progression by performing simple linear regression on global and sectorial mean deviations values generated for RNFLT (RNFLT-MD) and VF data (VF-MD). The proportion of eyes identified as progressing (positive rate) by RNFLT-MD and by VF-MD were compared within each classification.
Whereas both parameters performed similarly among glaucomatous optic neuropathy only and definite glaucoma eyes, the positive rate obtained with global RNFLT-MD was significantly greater compared with global VF-MD by 33.3% and 30.8% among ocular hypertension eyes and GVF eyes, respectively. This finding was consistent in the inferotemporal sector; however, similar positive rates were obtained for both parameters in the superotemporal sector.
While both RNFLT and VF parameters showed comparable abilities to identify progression across the different classifications, RNFLT assessment may be better suited to monitor progression, particularly among patients with elevated intraocular pressure and those who present with only GVF defect at baseline.
在原发性开角型青光眼的不同基线分类中，通过评估视网膜神经纤维层厚度来识别青光眼进展比监测视野（VF）损失更为频繁。
旨在比较视网膜神经纤维层厚度（RNFLT）和 VF 评估在原发性开角型青光眼的不同基线分类中对青光眼进展的检测。
本研究包括从诊断创新在青光眼研究（DIGS）和非裔美国人青光眼评估研究（ADAGES）中选择的至少 9 次随访的 194 名患者的 194 只眼睛。每只眼睛根据基线临床体征进行分类：高眼压（n=39）、仅青光眼视神经病变（n=60）、仅青光眼视野缺损（GVF，n=39）和明确青光眼（同时存在视盘和 VF 缺损，n=56）。我们通过对 RNFLT（RNFLT-MD）和 VF 数据（VF-MD）的全局和扇区平均偏差值进行简单线性回归来评估进展。在每个分类中，比较 RNFLT-MD 和 VF-MD 确定的进展眼的比例（阳性率）。
虽然在仅青光眼视神经病变和明确青光眼眼中，两个参数的表现相似，但在高眼压眼和 GVF 眼中，全局 RNFLT-MD 的阳性率分别比全局 VF-MD 高 33.3%和 30.8%。这一发现在下颞区是一致的；然而，在颞上区，两个参数的阳性率相似。
虽然 RNFLT 和 VF 参数在不同分类中都具有相当的识别进展能力，但 RNFLT 评估可能更适合监测进展，特别是在眼压升高和基线时仅存在 GVF 缺损的患者中。
