Korean J Ophthalmol.  2012 Jun;26(3):174-181. 10.3341/kjo.2012.26.3.174.

Glaucoma Progression Detection by Retinal Nerve Fiber Layer Measurement Using Scanning Laser Polarimetry: Event and Trend Analysis

• Moon BG
• Sung KR
• Cho JW
• Kang SY
• Yun SC
• Na JH
• Lee Y
• Kook MS

• KMID: 1376122
• DOI: http://doi.org/10.3341/kjo.2012.26.3.174

Abstract

PURPOSE
To evaluate the use of scanning laser polarimetry (SLP, GDx VCC) to measure the retinal nerve fiber layer (RNFL) thickness in order to evaluate the progression of glaucoma.
METHODS
Test-retest measurement variability was determined in 47 glaucomatous eyes. One eye each from 152 glaucomatous patients with at least 4 years of follow-up was enrolled. Visual field (VF) loss progression was determined by both event analysis (EA, Humphrey guided progression analysis) and trend analysis (TA, linear regression analysis of the visual field index). SLP progression was defined as a reduction of RNFL exceeding the predetermined repeatability coefficient in three consecutive exams, as compared to the baseline measure (EA). The slope of RNFL thickness change over time was determined by linear regression analysis (TA).
RESULTS
Twenty-two eyes (14.5%) progressed according to the VF EA, 16 (10.5%) by VF TA, 37 (24.3%) by SLP EA and 19 (12.5%) by SLP TA. Agreement between VF and SLP progression was poor in both EA and TA (VF EA vs. SLP EA, k = 0.110; VF TA vs. SLP TA, k = 0.129). The mean (+/-standard deviation) progression rate of RNFL thickness as measured by SLP TA did not significantly differ between VF EA progressors and non-progressors (-0.224 +/- 0.148 microm/yr vs. -0.218 +/- 0.151 microm/yr, p = 0.874). SLP TA and EA showed similar levels of sensitivity when VF progression was considered as the reference standard.
CONCLUSIONS
RNFL thickness as measurement by SLP was shown to be capable of detecting glaucoma progression. Both EA and TA of SLP showed poor agreement with VF outcomes in detecting glaucoma progression.

Keyword

Event analysis; Glaucoma; Progression; Scanning laser polarimetry; Trend analysis

MeSH Terms

Disease Progression
Female
Glaucoma/*diagnosis
Humans
Male
Middle Aged
Retinal Ganglion Cells/*pathology
Retrospective Studies
Scanning Laser Polarimetry/*methods
Severity of Illness Index

Figure

• 

  Fig. 1 Venn diagram showing agreement of glaucoma progression detection among the four tested methods (visual field [VF] event analysis [EA], VF trend analysis [TA], scanning laser polarimetry [SLP] EA, and SLP TA).

• 

  Fig. 2 Clinical example showing visual field (VF) data and scanning laser polarimetry (SLP) retinal nerve fiber layer (RNFL) information in a 54-year old woman with glaucomatous eyes. This patient was a 54-year old woman with open- angle glaucoma and had an inferior VF defect in the left eye at baseline (A). The SLP image showed a thinning of the RNFL where the average RNFL thickness was 40.71 µm (B). After 2 years of follow-up, the average RNFL thickness was significantly reduced to 30.7 µm, D), which corresponded with VF progression (C).

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