Prediction of Glaucoma Progression with Structural Parameters: Comparison of Optical Coherence Tomography and Clinical Disc Parameters.

PURPOSE To test the hypothesis that baseline optical coherence tomography (OCT) measures predict visual field (VF) progression in a cohort of patients with suspected or established glaucoma and compare their performance to semiquantitative optic disc measures. DESIGN Observational cohort study. METHODS Setting: Academic institution. STUDY POPULATION One-hundred seventy-one eyes of 95 patients with good-quality baseline retinal nerve fiber layer (RNFL) and macular OCT images and disc photographs with >2 years of follow-up and ≥5 VFs. OBSERVATION PROCEDURES Baseline macular and RNFL OCT measures and cup-to-disc ratio and disc damage likelihood score. MAIN OUTCOME MEASURES Prediction of glaucomatous visual field deterioration according to trend and event analyses. RESULTS Median (IQR) baseline mean deviation and follow-up were -2.9 (-6.4 to -1.1) dB and 54 (44-65) months, respectively. Seventeen and 25 eyes progressed by final visit based on pointwise event analysis and trend analysis of Visual Field Index (VFI), respectively. Thinner CCT (p =0.005), female gender (p =0.015), and thinner average pRNFL (p =0.001) predicted VF progression on proportional hazard models. Thinner RNFL at baseline (p =0.006) or thinner average GCIPL (p =0.028) along with higher baseline VFI (p =0.018 and 0.048, respectively) predicted VFI progression. Neither optic disc measures predicted VF progression in any of the explored models. CONCLUSIONS Baseline structural OCT measures predicted subsequent VF progression in contrast to semiquantitative optic disc measures. OCT-based structural measures should be included in prognostic models of glaucomatous VF deterioration.

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