Agreement for Detecting Glaucoma Progression with the GDx Guided Progression Analysis, Automated Perimetry, and Optic Disc Photography

Abstract Purpose To investigate the value of pattern electroretinography (PERG) and photopic negative response (PhNR) in monitoring glaucoma compared to standard clinical tests (standard automated perimetry (SAP) and clinical optic disc assessment) and structural measurements using spectral-domain OCT. Methods A prospective study included 32 subjects (32 eyes) with ocular hypertension, suspect or early glaucoma monitored for progression with clinical examination, SAP, PERG, PhNR and OCT for at least 4 years. Progression was defined clinically by the documented change of the optic disc and/or significant visual field progression (EyeSuite™ trend analysis). One eye per patient was included in the analysis. Results During the follow-up, 13 eyes (40.6%) showed progression, whereas 19 remained stable. In the progressing group, all parameters showed significant worsening over time, except for the PhNR, whereas in the stable group only the OCT parameters showed a significant decrease at the last visit. The trend of change over time using linear regression was steepest for the OCT parameters. At baseline, only the ganglion cell complex (GCC) and peripapillary retinal nerve fibre (pRNFL) thicknesses significantly discriminated between the stable and progressing eyes with the area under the ROC curve of 0.72 and 0.71, respectively. The inter-session variability for the first two visits in the stable group was lower for OCT (% limits of agreement within ± 17.4% of the mean for pRNFL and ± 3.6% for the GCC thicknesses) than for ERG measures (within ± 35.9% of the mean for PERG N95 and ± 59.9% for PhNR). The coefficient of variation for repeated measurements in the stable group was 11.9% for PERG N95 and 23.6% for the PhNR, while it was considerably lower for all OCT measures (5.6% for pRNFL and 1.7% for GCC thicknesses). Conclusions Although PERG and PhNR are sensitive for early detection of glaucomatous damage, they have limited usefulness in monitoring glaucoma progression in clinical practice, mainly due to high inter-session variability. On the contrary, OCT measures show low inter-session variability and might have a predicting value for early discrimination of progressing cases.

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The Relationship between Recurrent Optic Disc Hemorrhage and Glaucoma Progression

Ophthalmology ◽

10.1016/j.ophtha.2005.12.018 ◽

2006 ◽

Vol 113 (4) ◽

pp. 598-602 ◽

Cited By ~ 68

Author(s):

Seok Hwan Kim ◽

Ki Ho Park

Keyword(s):

Optic Disc ◽

Disc Hemorrhage ◽

Glaucoma Progression ◽

The Relationship

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Structural Changes Observed with Clinical Progression of Glaucoma

European Ophthalmic Review ◽

10.17925/eor.2009.03.02.30 ◽

2009 ◽

Vol 03 (02) ◽

pp. 30

Author(s):

Fotis Topouzis ◽

Panayiota Founti ◽

◽

Keyword(s):

Optic Disc ◽

Structural Damage ◽

Structural Changes ◽

Visual Field Defects ◽

Limited Information ◽

Clinical Progression ◽

Glaucoma Progression ◽

Glaucomatous Damage ◽

Colour Photography ◽

Field Defects

Glaucoma progression can be assessed based on the worsening of functional and/or structural damage. The importance of assessing structural changes relies on the fact that these usually precede visual field defects in the course of glaucoma. Changes in specific optic disc features denoting glaucoma progression can be clinically observed, while the occurrence of disc haemorrhages is considered to be a risk factor for glaucoma progression. To date, colour photography of the optic disc is the standard method for documenting and monitoring glaucoma in clinical practice and research studies. However, there are several limitations related to the use of colour photography. These mainly involve moderate to poor reproducibility in assessing glaucoma progression and limited information provided on the amount of glaucomatous damage progression.

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Correction: Impact of optic disc hemorrhage on subsequent glaucoma progression in mild-to-moderate myopia

PLoS ONE ◽

10.1371/journal.pone.0198647 ◽

2018 ◽

Vol 13 (5) ◽

pp. e0198647

Author(s):

Ahnul Ha ◽

Young Kook Kim ◽

Jin Wook Jeoung ◽

Ki Ho Park

Keyword(s):

Optic Disc ◽

Disc Hemorrhage ◽

Glaucoma Progression

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Spatial Relationship of Motion Automated Perimetry and Optic Disc Topography in Patients with Glaucomatous Optic Neuropathy

Journal of Glaucoma ◽

10.1097/00061198-199910000-00002 ◽

1999 ◽

Vol 8 (5) ◽

pp. 281???289 ◽

Cited By ~ 11

Author(s):

Charles F. Bosworth ◽

Pamela A. Sample ◽

Julia M. Williams ◽

Linda Zangwill ◽

Brian Lee ◽

...

Keyword(s):

Optic Disc ◽

Optic Neuropathy ◽

Spatial Relationship ◽

Glaucomatous Optic Neuropathy ◽

Automated Perimetry ◽

Relationship Of

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Оptical coherence tomography and optical coherence tomography-angiography in determining the progression of glaucoma

POINT OF VIEW EAST – WEST ◽

10.25276/2410-1257-2021-1-26-31 ◽

2021 ◽

pp. 26-31

Author(s):

N.I. Kurysheva ◽

◽

A.D. Nikitina ◽

Keyword(s):

Optical Coherence Tomography ◽

Functional Assessment ◽

Oct Angiography ◽

Ganglion Cell Complex ◽

Automated Perimetry ◽

Optical Coherence ◽

Complex Dynamic ◽

Glaucoma Progression ◽

Primary Glaucoma ◽

Sd Oct

Purpose. To study the role of optical coherence tomography (OCT) and OCT angiography (OCTA) in the detection of the primary glaucoma progression. Material and methods. The prospective study of 128 patients with primary glaucoma (128 eyes), conducted from 2015 to 2019, included at least 6 standard automated perimetry (SAP) and spectral-domain OCT (SD-OCT) examinations in each patient; OCTA was also used during the last year of observation. To determine the disease progression, the trend and event analysis using the Humphrey Field Analyzer was performed. The fact and rate of thinning of the retinal nerve fiber layer (RNFL) and its ganglion cell complex (GCC) were evaluated. If they had a trend of significant (p < 0.05) thinning, the eye was classified as having the SD-OCT progression. The values of corneal-compensated IOP were also considered: minimal (IOPmin) and peak (IOPmax). Results. Glaucoma progression was detected in 79 eyes. The isolated use of SAP allows detecting the progression only in 2.3% cases, SD-OCT - in 37.5%, among them the isolated assessment of GCC amounted to 7.8%, and RNFL – to 5.5%. The complex dynamic morphological and functional assessment increased the possibility of progression detection up to 61.7%. Progression was related to the stage of glaucoma damage at the moment of diagnosis: for the perimetry index PSD p=0.025, for the focal loss volume of GCC p=0.024, as well as with the level of minimal IOP (p=0.04). All patients with progression have shown the vessel density decrease in the peripapillary retina and parafovea. Conclusion. SD-OCT plays an important role in detecting the progression of glaucoma. The complex dynamic morphological and functional assessment allows detecting the progression in over half of patients. Progression is associated with the initial stage of glaucoma and an insufficient IOP decrease during treatment, accompanied by retinal microcirculation deterioration. Key words: primary, glaucoma progression, optical coherence tomography, OCT-angiography, IOP.

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Association of foveal avascular zone area withstructural and functional progression in glaucoma patients

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-318065 ◽

2021 ◽

pp. bjophthalmol-2020-318065

Author(s):

Fei Li ◽

Fengbin Lin ◽

Kai Gao ◽

Weijing Cheng ◽

Yunhe Song ◽

...

Keyword(s):

Optic Disc ◽

Capillary Density ◽

Cox Proportional Hazards Model ◽

Foveal Avascular Zone ◽

Systemic Hypertension ◽

Mean Deviation ◽

Inner Plexiform Layer ◽

Glaucoma Progression ◽

Avascular Zone ◽

Capillary Plexus

BackgroundTo investigate whether quantitative optical coherence tomography angiography (OCTA) metrics of the superficial/deep macular retina and optic disc are associated with glaucoma progression risk.MethodsA total of 238 eyes from 119 patients with open angle glaucoma or ocular hypertension, and no history of systemic hypertension or diabetes mellitus were included. All participants underwent OCTA imaging with a swept-source OCT (DRI-OCT 1, Topcon, Japan). OCTA metrics of superficial capillary plexus (SCP) and deep capillary plexus (DCP) in the macular region, and radial peripapillary capillary network of the optic disc were measured by a customised MATLAB program to obtain foveal avascular zone (FAZ) area, FAZ circularity and capillary density of SCP/DCP, and capillary density of the peripapillary region. Relationships between baseline OCTA metrics, visual field (VF) metrics, intraocular pressure fluctuation and risk of glaucoma progression were analysed with the Cox proportional hazards model. A frailty model was used to adjust for intereye correlation.ResultsDuring a mean follow-up duration of 29.39 months (range 12–56 months), 50, 48 and 16 eyes were determined to have retinal nerve fibre layer (RNFL), ganglion cell-inner plexiform layer (GC-IPL) and VF progression respectively. FAZ area per SD increase at baseline were significantly associated with both RNFL thinning (HR 1.73 95% CI 1.04 to 2.90); p=0.036) and GC-IPL thinning (HR 2.62, 95% CI 1.59 to 4.31; p<0.001), after adjusting for age, axial length and other potential confounding factors. VF progression was associated with age (HR 1.05, 95% CI 1.02 to 1.08; p<0.001) and mean deviation value (HR 0.91, 95% CI 0.84 to 0.98; p=0.010), but not with any OCTA metrics.ConclusionEnlarged FAZ area measured by OCTA was associated with a higher risk of RNFL and GC-IPL thinning associated with glaucoma, but not with functional deterioration in glaucoma.

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Applications of deep learning in detection of glaucoma: A systematic review

European Journal of Ophthalmology ◽

10.1177/1120672120977346 ◽

2020 ◽

pp. 112067212097734

Author(s):

Delaram Mirzania ◽

Atalie C Thompson ◽

Kelly W Muir

Keyword(s):

Systematic Review ◽

Deep Learning ◽

Clinical Settings ◽

Automated Perimetry ◽

Functional Tests ◽

Standard Automated Perimetry ◽

Glaucoma Progression ◽

Novel Technique ◽

Fundus Photographs ◽

Level Performance

Glaucoma is the leading cause of irreversible blindness and disability worldwide. Nevertheless, the majority of patients do not know they have the disease and detection of glaucoma progression using standard technology remains a challenge in clinical practice. Artificial intelligence (AI) is an expanding field that offers the potential to improve diagnosis and screening for glaucoma with minimal reliance on human input. Deep learning (DL) algorithms have risen to the forefront of AI by providing nearly human-level performance, at times exceeding the performance of humans for detection of glaucoma on structural and functional tests. A succinct summary of present studies and challenges to be addressed in this field is needed. Following PRISMA guidelines, we conducted a systematic review of studies that applied DL methods for detection of glaucoma using color fundus photographs, optical coherence tomography (OCT), or standard automated perimetry (SAP). In this review article we describe recent advances in DL as applied to the diagnosis of glaucoma and glaucoma progression for application in screening and clinical settings, as well as the challenges that remain when applying this novel technique in glaucoma.

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Kinetic and static perimetry after 16 years and additional OCT-A analysis in eyes with long-lasting optic disc drusen

PLoS ONE ◽

10.1371/journal.pone.0247399 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0247399

Author(s):

Edyta Koman-Wierdak ◽

Katarzyna Nowomiejska ◽

Agnieszka Brzozowska ◽

Dominika Nowakowska ◽

Mario Damiano Toro ◽

...

Keyword(s):

Optic Disc ◽

Superficial Layer ◽

Retinal Nerve Fibre Layer ◽

Macular Thickness ◽

Vessel Density ◽

Control Group ◽

Automated Perimetry ◽

Kinetic Perimetry ◽

Rnfl Thickness ◽

Optic Disc Drusen

The aim of the study is to evaluate the progression of visual field (VF) defects over 16 years of observation and to assess abnormalities in vessels and retinal nerve fibre layer (RNFL) thickness in patients with optic disc drusen (ODD). Both static automated perimetry (SAP) and semi-automated kinetic perimetry (SKP) were performed in 16 eyes of 8 patients (mean age 54 years) with ODD among 26 eyes of 13 patients examined 16 years before. The area of I2e, I4e, III4e, and V4e isopters was measured in deg2. The MD and PSD parameters were estimated using SAP. Optical coherence tomography angiography (OCT-A) was additionally performed in 16 ODD eyes and 16 eyes of 8 healthy subjects to estimate the RNFL thickness and vessel density of the optic nerve disc and the macula. The differences in all isopter areas of SKP and SAP parameters after 16 years were not significant. The analysis of OCT-A showed a significant reduction of the vessel density and RNFL of the peripapillary area in each segment in patients with ODD, compared with the control group. The highest reduction of RNFL was observed in the superior segment of the optic disc area (92.56μm vs 126.63μm) also the macular thickness was decreased in ODD patients, compared with the control group. In the macula, there was a significant vascular defect in the whole superficial layer and in the parafoveal deep layer. A strong significant correlation of the parafoveal deep plexus with MD and PSD parameters was detected. In conclusion, VF loss due to ODD after 16 years of the follow-up was not significant both in SKP and SAP. ODD caused a reduced vessel density and RNFL, as well as macular thickness in OCT-A. SAP parameters were influenced by parafoveal deep plexus.

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