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Abstract #90534 Published in IGR 21-3
The Trajectory of Glaucoma Progression in 2-Dimensional Structural-Functional Space
de Gainza A; Morales E; Salazar Vega DC; Mohammadzadeh V; Yu F; Afifi A; Nouri-Mahdavi K; Caprioli JOphthalmology. Glaucoma 2020; 3: 466-474
PURPOSE: To present a method that allows visualization of functional and structural change in 2-dimensional space. DESIGN: Retrospective, longitudinal, observational study. PARTICIPANTS: Patients from the Stein Eye Institute, UCLA from 1993 through 2017. METHODS: Patients were arranged into 2 cohorts. Cohort 1 was used to create a structural score for the horizontal axis of the structural-functional (S-F) 2-dimensional space. The visual field (VF) index was used for the vertical axis as the functional score. Cohort 2 was used to apply those scores for analysis of S-F progression with a combined vector. The first cohort included eyes with mild glaucoma (abnormal glaucoma hemifield test results, pattern standard deviation <0.05 on 2 examinations, or mean deviation [MD] >-5 dB) and normal control participants. The second cohort included all stages of open-angle glaucoma with ≥5 OCT retinal nerve fiber layer scans, ≥5 reliable visual field (VF) results, and follow-up of ≥4 years. MAIN OUTCOME MEASURES: Vectors were created for each eye to represent the trajectory of glaucoma progression over time. Each vector was defined by structural (x-axis) and functional (y-axis) components. The structural component was calculated with a linear model of Heidelberg Retina Tomograph (Heidelberg Engineering, Heidelberg, Germany) scores over time. The functional component was calculated with a linear model of VF measurements over time. The resultant vector and its confidence interval were plotted in 2-dimensional S-F space. Eyes were divided into severity stages based on baseline MD. A mean vector was calculated for each severity stage. RESULTS: We obtained 290 vectors from 290 eyes of 196 patients. The mean ± standard deviation follow-up period was 14.6±3.1 years. Average age was 58.6±8.8 years. Preperimetric, mild, moderate, and severe categories included 41, 89, 97, and 63 eyes, respectively. Mean baseline MDs were 0.8 dB, -0.95 dB, -3.57 dB, and -11.51 dB, respectively, and mean vector slopes for each severity categories were 0.79, 0.95, 1.95, and 2.08, respectively. Cook's distance removed 131 (7.1%) and 137 (7.4%) outliers from the structure and function regressions, respectively. CONCLUSIONS: We report a method to visualize the trajectory of a patient's glaucoma progression in a 2-dimensional S-F space. The slope of the trajectory of glaucoma progression is a function of the severity of the disease.
Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
Full articleClassification:
6.20 Progression (Part of: 6 Clinical examination methods)
6.6.2 Automated (Part of: 6 Clinical examination methods > 6.6 Visual field examination and other visual function tests)
6.9.2.2 Posterior (Part of: 6 Clinical examination methods > 6.9 Computerized image analysis > 6.9.2 Optical coherence tomography)
