Korean J Ophthalmol.  2020 Feb;34(1):56-66. 10.3341/kjo.2019.0112.

Hierarchical Cluster Analysis of Peripapillary Retinal Nerve Fiber Layer Damage and Macular Ganglion Cell Loss in Open Angle Glaucoma

Affiliations
  • 1Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. kcyeye@yuhs.ac

Abstract

PURPOSE
To categorize the structural progression pattern of glaucoma, as detected by optical coherence tomography guided progression analysis, with respect to the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL).
METHODS
One hundred sixty-four eyes with primary open-angle glaucoma were studied. The structural progression pattern evaluated by optical coherence tomography guided progression analysis was classified using hierarchical cluster analysis. The clinical parameters, patterns of structural progression, and visual field (VF) changes were compared among the groups.
RESULTS
Three groups were included: stable, progressive peripapillary RNFL thinning without macular GCIPL involvement, and progressive thinning of both the peripapillary RNFL and macular GCIPL. The third group, those with progressive peripapillary RNFL and macular GCIPL thinning, showed more progressive peripapillary RNFL thinning in the inferotemporal area and VF progression in the parafoveal area. Conversely, the 12 and 6 o'clock areas were the most common locations of progressive peripapillary RNFL thinning in the group without macular GCIPL involvement.
CONCLUSIONS
Structural progression patterns of glaucoma can be categorized into three groups. The location of progressive peripapillary RNFL thinning is associated with progressive macular GCIPL thinning and pattern of VF changes in the affected area. Our results indicate that the use of only macular GCIPL analysis is inadequate for analyzing the structural progression of glaucoma.

Keyword

Glaucoma; Machine learning; Open angle; Optical coherence tomography

MeSH Terms

Cluster Analysis*
Ganglion Cysts*
Glaucoma
Glaucoma, Open-Angle*
Machine Learning
Nerve Fibers*
Retinaldehyde*
Tomography, Optical Coherence
Visual Fields
Retinaldehyde

Figure

  • Fig. 1 Pattern deviation plot divided into the two subfields of the Humphrey visual field. Parafoveal scotoma defect (circle) and peripheral nasal step defect (triangle).

  • Fig. 2 Dendrogram showing the three clusters classified using hierarchical cluster analysis.

  • Fig. 3 Characteristic examples of each group. (A) An example of a 35-year-old woman with primary open-angle glaucoma exhibiting stable changes in the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL). No progression of GCIPL or RNFL thinning was detected using guided progression analysis (GPA); the visual field (VF) defect was also stable during follow-up. (B) An example of a 61-year-old man with primary open-angle glaucoma showing progressive thinning of the peripapillary RNFL with little change in the macular GCIPL. The GPA revealed progression of peripapillary RNFL thinning at the superotemporal (or supero-superior) area on October 20, 2017, but no structural change was found in the GCIPL GPA. Following linear regression analysis of mean deviation, the VF defect did not appear to progress, but the progression of the lower peripheral VF defect was highly suspicious when comparing the actual test results. (C) An example of a 56-year-old woman with primary open-angle glaucoma showing progression of RNFL and GCIPL thinning on GPA. A progressive peripapillary RNFL defect was first found at the inferotemporal area on November 25, 2015, and a second defect was found on December 13. On November 25, 2015, progressive GCIPL thinning was found at the inferior macula. Linear regression analysis of mean deviation showed significant progression of the VF defect (p = 0.02).


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