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Editors Selection IGR 13-2
Basic Research: Rate of change
Comment by Murray Fingeret on:
26792 A comparison of rates of change in neuroretinal rim area and retinal nerve fiber layer thickness in progressive glaucoma, Alencar LM; Zangwill LM; Weinreb RN et al., Investigative Ophthalmology and Visual Science, 2010; 51: 3531-3539
The recognition of change in individuals with glaucoma is an important hallmark of management. As clinicians follow their patients with glaucoma over time, one question is whether change more commonly occurs in the retinal nerve fiber layer (RNFL) or the neuroretinal rim. Also, while stereo photographs or visual fields have been the gold standard for recognizing change, the use of imaging technology to detect progression is increasing. In this study, Alencar et al. (1152) assessed the ability of scanning laser polarimetry (GDx- VCC; Carl Zeiss Meditec, inc. Dublin, CA) and confocal scanning laser ophthlamoscopy (HRT-3; Heidelberg Engineering, Heidelberg, Germany) to detect loss in individuals with documented progressive change (either visual field change or optic nerve progression as seen by stereo photographs). Because each imaging instrument is optimized to evaluate a specific structure (GDX-RNFL, HRT-rim area), the paper could also be seen as a referendum for whether change more commonly occurs in one of these structures. In this observational cohort study, using data from two longitudinal trials (Diagnostic Innovations in Glaucoma Study - DIGS and African Descent and Evaluation Study ‐ADAGES), change was more commonly detected with RNFL assessment than with rim area (RA) evaluation. Because two different technologies are involved, the fact that RNFL change was more common may relate to the technology used and not how glaucoma progresses. The studies used in this paper were begun several years ago, and imaging instrumentation has evolved significantly. The HRT or GDx may have been supplanted by spectral optical coherence tomography (OCT) with its improved resolution. Spectral OCT is capable of evaluating multiple structures: the RNFL, RA as well as posterior pole. Further studies are needed to demonstrate whether spectral OCTs will improve our ability to detect change and if so, does change occur in one particular area.
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