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Abstract #53213 Published in IGR 15-1
The rate of structural change: the confocal scanning laser ophthalmoscopy ancillary study to the ocular hypertension treatment study
Zangwill LM; Jain S; Dirkes K; He F; Medeiros FA; Trick GL; Brandt JD; Cioffi GA; Coleman AL; Liebmann JM; Piltz-Seymour JR; Gordon MO; Kass MA; Weinreb RN;American Journal of Ophthalmology 2013; 155: 971-982
PURPOSE: To compare rates of topographic change in ocular hypertensive eyes that develop primary open-angle glaucoma (POAG) compared to eyes that do not, and to identify factors that influence the rate of change. DESIGN: Longitudinal, randomized clinical trial. METHODS: Four hundred forty-one participants (832 eyes) in the Confocal Scanning Laser Ophthalmoscopy Ancillary Study to the Ocular Hypertension Treatment Study were included. POAG was defined as repeatable visual field, photography-based optic disc changes, or both. The rate of topographic change in the 52 participants (66 eyes) who developed POAG was compared with that of participants who did not develop POAG using multivariable mixed effects models. RESULTS: In both univariate and multivariate analyses, the rate of rim area loss was significantly faster in eyes in which POAG developed than in eyes in which it did not (univariate mean, -0.0131 mm(2)/year and -0.0026 mm(2)/year, respectively). The significantly faster rate of rim area loss in black persons found in the univariate analysis did not remain significant when baseline disc area was included in the model. In multivariate analyses, the rate of rim area loss and other topographic parameters also was significantly faster in eyes with worse baseline visual field pattern standard deviation and higher intraocular pressure during follow-up. Moreover, a significant rate of rim area loss was detected in eyes in which POAG did not develop (P < .0001). The rate of rim area loss in eyes with an optic disc POAG endpoint was significantly faster than in those with a visual field POAG endpoint. CONCLUSIONS: The rate of rim area loss is approximately 5 times faster in eyes in which POAG developed compared with eyes in which it did not. These results suggest that measuring the rate of structural change can provide important information for the clinical management of ocular hypertensive patients. Additional follow-up is needed to determine whether the statistically significant change in the eyes in which POAG did not develop represents normal aging or glaucomatous change not detected by conventional methods.
Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California. Electronic address: lzangwill@ucsd.edu.
Full articleClassification:
6.9.1.1 Confocal Scanning Laser Ophthalmoscopy (Part of: 6 Clinical examination methods > 6.9 Computerized image analysis > 6.9.1 Laser scanning)
6.20 Progression (Part of: 6 Clinical examination methods)
2.14 Optic disc (Part of: 2 Anatomical structures in glaucoma)
