The Assessment of Morphological and Functional Changes in the Detection of the Initial Stage of Primary Glaucoma

Purpose — to study morphological and functional changes in the detection of primary glaucoma progression.Patients and methods. 128 patients (128 eyes, among them — 64 eyes with primary open angle glaucoma (POAG) and 64 with primary angle closure glaucoma (PACG)) with the initial MD of –6.0 dB were examined at the Ophthalmology Center of the FMBA of Russia from May 2016 to November 2019. The values of corneal-compensated IOP were also considered: minimal (IOPmin), peak (IOPmax) and its fluctuations (IOPfluct). The progression was measured using standard automated perimetry (SAP) and spectral-domain OCT (SD-OCT). During the observation period, each patient received the average of 8.42 ± 2.08 SAP and SD-OCT. Progressive thinning of the retinal nerve fiber layer (RNFL) and its ganglion cell complex (GCC) were evaluated using SD-OCT. If RNFL and/or GCC had a trend of significant (p < 0.05) thinning, the eye was classified as having the SD-OCT progression. The correlation between the rate of progression detected by SAP (ROP1) using thinning of RNFL (ROP2) and GCC (ROP3) with other clinical parameters was analyzed.Results and discussion. Glaucoma progression was detected in 73 eyes. While the isolated use of SAP did not allow detecting progression, it was possible to detect it in 39 % cases by SD-OCT. The combination of both methods allowed detecting progression in 57 %. In both forms, ROP1 correlated with IOPmin: in PACG r = 0.41, p = 0.023 and in POAG r = 0.43, p = 0.016. In PACG, ROP2 and ROP3 correlated with the foveal choroid thickness: r = 0.46, p = 0.019 and r = 0.47, p = 0.009, respectively. At the same time, ROP3 was associated with peak IOP (r = –0.402, p = 0.025); the correlation of peak IOP with its fluctuations amounted to 0.7 (p < 0.001).Conclusion. SD-OCT is more informative than SAP in determining the progression of the initial primary glaucoma. The combination of these two methods 1.5 times increases the possibility of detecting progression in comparison with the isolated use of SD-OCT. The choroid thickness, associated with the IOP fluctuations, plays an important role in the progression of PACG.

Download Full-text

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.

Download Full-text

Ganglion cell complex scan in the early prediction of glaucoma

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v4i2.6538 ◽

2012 ◽

Vol 4 (2) ◽

pp. 236-241

Author(s):

S Ganekal

Keyword(s):

Ganglion Cell ◽

Cell Complex ◽

P Value ◽

Ganglion Cell Complex ◽

Automated Perimetry ◽

Standard Automated Perimetry ◽

Fiber Layer ◽

Color Code ◽

Rnfl Thickness ◽

Significant Difference

Objective: To compare the macular ganglion cell complex (GCC) with peripapillary retinal fiber layer (RNFL) thickness map in glaucoma suspects and patients. Subjects and methods: Forty participants (20 glaucoma suspects and 20 glaucoma patients) were enrolled. Macular GCC and RNFL thickness maps were performed in both eyes of each participant in the same visit. The sensitivity and specificity of a color code less than 5% (red or yellow) for glaucoma diagnosis were calculated. Standard Automated Perimetry was performed with the Octopus 3.1.1 Dynamic 24-2 program. Statistics: The statistical analysis was performed with the SPSS 10.1 (SPSS Inc. Chicago, IL, EUA). Results were expressed as mean ± standard deviation and a p value of 0.05 or less was considered significant. Results: Provide absolute numbers of these findings with their units of measurement. There was a statistically significant difference in average RNFL thickness (p=0.004), superior RNFL thickness (p=0.006), inferior RNFL thickness (p=0.0005) and average GCC (p=0.03) between the suspects and glaucoma patients. There was no difference in optic disc area (p=0.35) and vertical cup/disc ratio (p=0.234) in both groups. While 38% eyes had an abnormal GCC and 13% had an abnormal RNFL thickness in the glaucoma suspect group, 98% had an abnormal GCC and 90% had an abnormal RNFL thickness in the glaucoma group.Conclusion: The ability to diagnose glaucoma with macular GCC thickness is comparable to that with peripapillary RNFL thickness. Macular GCC thickness measurements may be a good alternative or a complementary measurement to RNFL thickness assessment in the clinical evaluation of glaucoma.DOI: http://dx.doi.org/10.3126/nepjoph.v4i2.6538 Nepal J Ophthalmol 2012; 4 (2): 236-241

Download Full-text

Relationship between visual field changes and optical coherence tomography measurements in advanced open-angle glaucoma

Folia Medica ◽

10.1515/folmed-2016-0027 ◽

2016 ◽

Vol 58 (3) ◽

pp. 174-181 ◽

Cited By ~ 2

Author(s):

Snezhina S. Kostianeva ◽

Marieta I. Konareva-Kostianeva ◽

Marin A. Atanassov

Keyword(s):

Optical Coherence Tomography ◽

Visual Field ◽

Structural Changes ◽

Open Angle Glaucoma ◽

Mean Deviation ◽

Ganglion Cell Complex ◽

Automated Perimetry ◽

Optical Coherence ◽

Open Angle ◽

Sd Oct

Abstract Aim: To assess relationships between functional changes in visual field and structural changes in advanced open-angle glaucoma (OAG) found using spectral-domain optical coherence tomography (SD-OCT). Methods: Thirty-one eyes of 25 patients with OAG were included in this study. Besides the routine ophthalmological exam the patients underwent standard automated perimetry (SAP) (Humphrey Field Analyzer) and SD-OCT (RTVue–100) performed within 6 months. The global perimetric indices in the study group were as follows: mean deviation (MD) 12.33±6.18 dB and pattern standard deviation (PSD) 9.17±3.41 dB. The relationship between OCT measurements and MD and PSD was evaluated by correlation analysis (Pearson’s correlation coefficient) and regression analysis (linear and nonlinear regression models). Results: Thickness measurements of the lower halves of ganglion cell complex (GCC) and retinal nerve fiber layer by two scanning protocols (ONH and 3.45) showed these to be thinner than the upper halves, but the difference failed to reach statistical significance. The correlations between global indices MD/PSD and most of the analysed quantitative OCT measurements were moderate (r in the range between 0.3 and 0.6). The correlation between MD and GCC showed nonlinear cubic regression (R2=0.417, P=0.004). Good correlation was found between MD and GLV (R2=0.383; P=0.008). Linear regression (P<0.05) was found only between MD and Cup area (R2=0.175, P=0.024) and between MD and RNFL by 3.45 protocol (R2=0.131, P=0.045). Conclusion: Nonlinear regressive models appear to be more appropriate in the assessment of the correlations between functional and structural changes in eyes with advanced glaucoma. The correlations we found were moderate.

Download Full-text

Monitoring for glaucoma progression with SAP, electroretinography (PERG and PhNR) and OCT

Documenta Ophthalmologica ◽

10.1007/s10633-021-09854-8 ◽

2021 ◽

Author(s):

Barbara Cvenkel ◽

Maja Sustar ◽

Darko Perovšek

Keyword(s):

Optic Disc ◽

Repeated Measurements ◽

Photopic Negative Response ◽

Ganglion Cell Complex ◽

Automated Perimetry ◽

Stable Group ◽

Standard Automated Perimetry ◽

Glaucoma Progression ◽

The Mean ◽

Over Time

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.

Download Full-text

Correlation of Structural and Functional Changes in Ocular Hypertension and Early Glaucoma

QJM ◽

10.1093/qjmed/hcaa058.019 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

W O Noureldin ◽

H M Ebiary ◽

R G Zaki

Keyword(s):

Ocular Hypertension ◽

Open Angle Glaucoma ◽

Automated Perimetry ◽

Fiber Layer ◽

Temporal Area ◽

Early Glaucoma ◽

Functional Changes ◽

Rnfl Thickness ◽

Group I

Abstract Purpose To estimate the link between the thickness of retinal nerve fiber layer (RNFL); utilizing optical coherence tomography (OCT) and corresponding retinal sensitivity changes; utilizing visual field (VF) perimetry, in cases of ocular hypertension and early glaucoma. Methods Thirty patients (60 eyes) were gathered for this prospective, cross-sectional study. They were categorized into two groups. Group I comprised 30 eyes (15 patients) having ocular hypertension. Group II comprised 30 eyes (15 patients) early recognized as primary open angle glaucoma. Each patient underwent a thorough ophthalmologic examination, OCT for RNFL thickness estimation using quick RNFL thickness protocol and VF testing using automated perimetry (G2 program, central 30–2 threshold protocol). Pearson’s correlation was premediated between thickness of RNFL and VF indices. Results Significant connections between the thickness of temporal area of RNFL and mean sensitivity (MS), mean defect (MD) and loss of variance (LV) indices of VF (r = 0.533, -0.431, -0.388; P < 0.01, respectively) were noticed in patients having ocular hypertension. Additionally, a significant link between the thickness of the temporal area of RNFL and MS index of VF (0.441; P < 0.05) was noticed in patients with early POAG. Otherwise, there were no significant links between indices of VF and other areas of RNFL thickness in both groups. Conclusion Average RNFL thickness is certifiably not a dependable index for early determination of glaucoma or for the follow-up of ocular hypertension and POAG. Segmental RNFL thickness (especially temporal) appears to be a more dependable index. Profound structural modification with OCT test comprises an imperative sign of early utilitarian changes, regardless of whether they are not yet recognized with perimetry. The MS index of VF is by all accounts sensitive for the follow-up of ocular hypertension.

Download Full-text

Transient Peripapillary Retinoschisis in Glaucomatous Eyes

Journal of Ophthalmology ◽

10.1155/2017/1536030 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Josine van der Schoot ◽

Koenraad A. Vermeer ◽

Hans G. Lemij

Keyword(s):

Imaging Techniques ◽

Scanning Laser ◽

Automated Perimetry ◽

Standard Automated Perimetry ◽

Fiber Layer ◽

Laser Polarimetry ◽

Laser Tomography ◽

Healthy Eyes ◽

Sd Oct

Purpose. To investigate transient focal microcystic retinoschisis in glaucomatous eyes in images obtained with several imaging techniques used in daily glaucoma care.Methods. Images of 117 glaucoma patients and 91 healthy subjects participating in a large prospective follow-up study into glaucoma imaging were reviewed. Participants were measured with spectral domain optical coherence tomography (SD-OCT), scanning laser polarimetry (SLP), scanning laser tomography (SLT), and standard automated perimetry (SAP). The presence of a focal retinoschisis in SD-OCT was observed and correlated to SLP, SLT, and SAP measurements, both cross-sectionally and longitudinally.Results. Seven out of 117 glaucoma patients showed a transient, localised, peripapillary, heterogeneous microcystic schisis of the retinal nerve fiber layer (RNFL) and sometimes other retinal layers as well in SD-OCT. None of the healthy eyes showed this phenomenon nor did any of the other imaging techniques display it as detailed and consistently as did the SD-OCT. SAP showed a temporarily decreased focal retinal sensitivity during the retinoschisis and we found no signs of glaucomatous progression related to the retinoschisis.Conclusions. Transient microcystic retinoschisis appears to be associated with glaucomatous wedge defects in the RNFL. It was best observed with SD-OCT and it was absent in healthy eyes. We found no evidence that the retinoschisis predicted glaucomatous progression.

Download Full-text

Optic Nerve Head Hemoglobin Levels in Glaucoma: A Structural and Functional Correlation Study

Journal of Ophthalmology ◽

10.1155/2021/9916102 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Janaina A. G. Rocha ◽

Diego T. Dias ◽

Maria Betânia C. Lemos ◽

Fábio N. Kanadani ◽

Augusto Paranhos ◽

...

Keyword(s):

Optic Nerve ◽

Optic Nerve Head ◽

Correlation Study ◽

Mean Deviation ◽

Automated Perimetry ◽

Standard Automated Perimetry ◽

Fiber Layer ◽

Wide Range ◽

Disease Stages ◽

Sd Oct

Purpose. To investigate structural and functional correlations in glaucoma patients using optic nerve head hemoglobin (ONH Hb) measurements as determined by automated colorimetric analysis of conventional retinography. Methods. We prospectively enrolled healthy participants and glaucomatous patients with a wide range of disease stages. All participants underwent visual field (VF) testing (standard automated perimetry, SAP), color fundus imaging (mydriatic retinography), and peripapillary retinal nerve fiber layer (pRNFL) assessment through spectral-domain optical coherence tomography (SD-OCT). Software Laguna ONhE was used to estimate the amount of ONH Hb and to determine the glaucoma discriminant function (GDF) index. Scatter plots were constructed, and regression analysis was used to investigate the correlations between GDF, average pRNFL thickness, and VF mean deviation (VFMD) index values. A secondary analysis was performed to compare each parameter between three different glaucoma groups divided according to VFMD values (mild, >−6 dB; moderate, −6 to −12 dB; and advanced, <−12 dB). Results. One hundred ninety-six eyes from 123 participants (69 with glaucoma and 54 controls) were enrolled. Overall, all parameters evaluated differed significantly between glaucomatous and control eyes ( p ≤ 0.001 ). The comparison of each parameter according to groups of disease stages revealed significant differences between controls and each of the glaucomatous groups ( p < 0.001 ). More pronounced changes in GDF values were observed in early disease stages. We found significant nonlinear correlations between GDF and VFMD values (R2 = 0.295, p < 0.001 ) and between pRNFL thickness and VFMD (R2 = 0.598, p < 0.001 ). A linear correlation was found between GDF and pRNFL thickness values (R2 = 0.195, p < 0.001 ). Conclusion. Our results showed significant associations between ONH Hb values and both structural and functional damage in glaucoma obtained by SD-OCT and SAP, respectively. The nonlinear correlation we found and the GDF behavior along different disease stages suggest that ONH Hb levels’ reduction may precede visual function changes in early glaucoma stages.

Download Full-text

Global Glaucoma Staging System (GGSS): A New Method to Simultaneously Assess the Severity of Both Functional and Structural Damage in Glaucoma

Journal of Clinical Medicine ◽

10.3390/jcm10194414 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4414

Author(s):

Paolo Brusini

Keyword(s):

Visual Field ◽

Structural Damage ◽

Open Angle Glaucoma ◽

Visual Fields ◽

Staging System ◽

Normal Subjects ◽

Automated Perimetry ◽

Standard Automated Perimetry ◽

Fiber Layer ◽

Spectral Domain Oct

Background: The classification of damage in glaucoma is usually based either on visual field or optical coherent tomography (OCT) assessment. No currently available method is able to simultaneously categorize functional and structural damage. Material and Methods: In this study, 283 patients with chronic open-angle glaucoma (OAG) at different stages and 67 healthy subjects were tested with both standard automated perimetry and spectral domain OCT for retinal nerve fiber layer (RNFL) assessment. The visual field data were classified using the Glaucoma Staging System 2, whereas OCT results were processed with the OCT Glaucoma Staging System. These data were used to create a new staging system (global glaucoma staging system, GGSS), in which the severity of visual field and RNFL damage is reported on the Y and X axis, respectively. The GGSS was tested in a different sample of 147 patients with manifest OAG, 56 with preperimetric glaucoma and 43 normal subjects. A six-stage clinical classification, based on the analysis of visual fields and optic disc appearance, was used as gold standard. Results: The GGSS was able to correctly classify in the same stage or within the immediately adjacent stages 145 cases on 147 (98.6%). Fifty-four preperimetric cases (96.4%) were classified as borderline or abnormal (Stage 1 or 2). Here, 41 normal eyes out of 43 were correctly classified as Stage 0, with a specificity of 95.3%. Conclusions: Preliminary results from this study are encouraging and suggest that the new GGSS is able to provide information concerning the severity of structural and functional damage in an integrated manner.

Download Full-text

A simplified combined index of structure and function for detecting and staging glaucomatous damage

Scientific Reports ◽

10.1038/s41598-021-82756-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Zhichao Wu ◽

Felipe A. Medeiros

Keyword(s):

Clinical Utility ◽

Mean Deviation ◽

Automated Perimetry ◽

Measurement Scales ◽

Empirical Formulas ◽

Fiber Layer ◽

Glaucomatous Damage ◽

Functional Changes ◽

Cell Counts ◽

Better Than

AbstractGlaucomatous damage results in characteristics structural and functional changes on optical coherence tomography (OCT) imaging and standard automated perimetry (SAP) testing. The clinical utility of these measures differs based on disease severity, as they are evaluated along different measurement scales. This study therefore sought to examine if a simplified combined structure–function index (sCSFI) could improve the detection and staging of glaucomatous damage, compared to the use of average retinal nerve fiber layer thickness (RNFL) measurements from OCT and mean deviation (MD) values from SAP alone, and also an estimated retinal ganglion cell counts (eRGC) measure derived using empirical formulas described previously. Examining 577 eyes from 354 participants with perimetric glaucoma and 241 normal eyes from 138 healthy participants, we found that the sCSFI performed significantly better than average RNFL, MD and eRGC count for discriminating between glaucoma and healthy eyes (P ≤ 0.008 for all). The sCSFI also performed significantly better than RNFL and eRGC count at discriminating between different levels of visual field damage in glaucoma eyes (P < 0.001 for both). These findings highlight the clinical utility of combining structural and functional information for detecting and staging glaucomatous damage using the simplified index developed in this study.

Download Full-text

Modern methods for assessing morphometric and functional indicators in primary glaucoma

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-1-83-87 ◽

2021 ◽

pp. 83-87

Author(s):

N.R. Sharvadze ◽

◽

A.L. Shtilerman ◽

D.P. Skachkov ◽

Y.A. Drovnyak ◽

...

Keyword(s):

Open Angle Glaucoma ◽

Diagnostic Methods ◽

High Tech ◽

Glaucomatous Optic Neuropathy ◽

Static Perimetry ◽

Functional Changes ◽

Modern Methods ◽

Analytical Review ◽

Primary Glaucoma ◽

Key Words Glaucoma

In the article are presented analytical review of scientific articles devoted to the study of modern methods of diagnostics of primary glaucoma. On the basis of scientific articles, a review material was collected and systematized on diagnostic methods for studying morphometric and functional changes in primary glaucoma, which are used in modern ophthalmic practice. In recent years, the improvement and implementation of new high-tech modern diagnostic methods open up new opportunities for researchers and clinicians. Optical coherence tomography, OCT angiography, static perimetry make it possible, by comparing morphometric and functional parameters, to give a more complete, comprehensive assessment of pathological changes in the optic nerve head, in the macular region and at the level of the choriocapillaries. Prevention of glaucoma blindness largely depends on its early diagnosis based on the use of modern organizational and medical technologies. Key words: glaucoma, open-angle glaucoma, intraocular pressure, glaucomatous optic neuropathy, diagnostic methods.

Download Full-text