Elsevier

Ophthalmology

Volume 118, Issue 4, April 2011, Pages 763-767
Ophthalmology

Original article
Evaluation of Retinal Nerve Fiber Layer Progression in Glaucoma: A Comparison between the Fast and the Regular Retinal Nerve Fiber Layer Scans

https://doi.org/10.1016/j.ophtha.2010.08.014Get rights and content

Objective

To compare the performance of the fast (256 A-scans in each scan circle) and the regular (512 A-scans in each scan circle) retinal nerve fiber layer (RNFL) scan protocols for detection of glaucoma progression using the Stratus optical coherence tomography (OCT) device (Carl Zeiss Meditec, Dublin, CA).

Design

Retrospective, longitudinal study.

Participants

One hundred twenty-nine eyes from 72 glaucoma patients.

Methods

All patients had been followed up for 2.9 to 6.1 years with a median follow-up of 4 months. All eyes had at least 4 serial RNFL measurements obtained with both the fast and the regular RNFL scans. Visual field (VF) assessment was performed on the same day as RNFL imaging. Retinal nerve fiber layer thickness and VF progression were evaluated with linear regression analysis against age. The mean rate of average RNFL thickness reduction was estimated with linear mixed modeling.

Main Outcome Measures

The agreement of progression detection and the rate of change of RNFL thicknesses.

Results

A total of 1373 fast and 1373 regular RNFL scans and 1236 VF tests were analyzed. With reference to the average RNFL thickness, the fast RNFL scan detected more eyes with progression (21 eyes from 19 patients vs. 15 eyes from 13 patients) than the regular scan at a comparable level of specificity (96.9% vs. 96.1%). More eyes were found to have increasing RNFL thickness with age at individual clock hours (except for 3, 5, 6, and 11 o'clock) when the measurements were obtained with the regular scan. The agreement between the fast and the regular scan for detection of RNFL progression was fair to moderate, with κ values ranging between 0.14 and 0.49. The rate of average RNFL thickness progression was −1.01 μm per year for the fast RNFL scan and −0.77 μm per year for the regular scan.

Conclusions

The choice of scan protocols in the Stratus OCT has a significant impact in the evaluation of RNFL progression. The fast RNFL scan seems to be preferable to follow RNFL damage in glaucoma.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Patients

One hundred twenty-nine eyes from 72 glaucoma patients followed up from March 2003 through August 2009 were included. At least 4 serial RNFL measurements were obtained from each eye with both the fast and regular RNFL scans at the same visit, and with the first and the last measurements separated by at least 2.9 years. All subjects underwent a full ophthalmic examination, including visual acuity, refraction, intraocular pressure measurement with Goldmann tonometry, gonioscopy, and fundus

Results

A total of 1373 fast RNFL scans with the corresponding 1373 regular RNFL scans and 1236 visual field tests collected from 129 eyes (72 glaucoma patients) were analyzed. The follow-up duration ranged between 2.9 to 6.1 years with a median follow-up of 4 months. The average number of OCT scans and visual field tests for each eye was 10.6 and 9.6, respectively. The average RNFL thicknesses measured with the fast and regular RNFL scans were 76.8±19.0 μm and 75.5±18.6 μm at baseline and 73.8±19.1 μm

Discussion

Despite the fact that both the fast and the regular RNFL measurements were collected in the same follow-up visits, the agreement for detection of progressive RNFL thickness reduction between the 2 scan protocols surprisingly was only fair to moderate, and the regular RNFL scan seems to be less specific for detecting clock hour RNFL progression. A significant proportion of eyes demonstrated increasing clock hour RNFL thicknesses with age when the measurements were obtained with the regular scan.

References (15)

There are more references available in the full text version of this article.

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Manuscript no. 2010-347.

Financial Disclosure(s): The author(s) have made the following disclosure(s):

Christopher Kai Shun Leung - Financial support - Carl Zeiss Meditec.

Robert Neal Weinreb - Consultant and Financial support - Carl Zeiss Meditec.

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