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Editors Selection IGR 11-1
Progression: Progressive functional and ONH changes
Comment by Christopher Girkin on:
24870 Prediction of functional loss in glaucoma from progressive optic disc damage, Medeiros FA; Alencar LM; Zangwill LM et al., Archives of Ophthalmology, 2009; 127: 1250-1256
Medeiros et al. (1525) have published an important study that prospectively evaluates the risk progressive functional injury associated with progressive changes in the structure of the nerve assessed by subjective evaluation of serial stereophotos in patients with optic nerve suspicious for early glaucomatous injury. The study utilized data from 639 eyes of 407 participants with glaucomatous appearing optic nerve heads with normal standard perimetry enrolled in the Diagnostics Innovations in Glaucoma Study (DIGS) who were followed a mean of eight years. Participants had yearly visual fields and optic disc stereophotos. In multivariable predictive models, progressive changes of the optic disc were highly predictive of visual field progression with an astounding hazard ratio of 25.8 (95% confidence interval, 16.0-41.7) and a predictive power [R(2)] of 79%.
Progressive changes of the optic disc are highly predictive of visual field progression
Other predictive factors included age, intraocular pressure, central corneal thickness, pattern standard deviation, and baseline stereophotograph grading show much less predictive power with a predictive accuracy ranging from 6 to 26%. This high association and predictive value of progressive disc change, further validates the critical need for photographic documentation of the optic disc on following patients with glaucoma clinically and largely serves to validate the use of serial stereo photography as an endpoint in clinical trials of agents aimed at reducing the rate of progressive glaucomatous injury.
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