Korean J Ophthalmol.  2015 Feb;29(1):31-39. 10.3341/kjo.2015.29.1.31.

Detecting the Progression of Normal Tension Glaucoma: A Comparison of Perimetry, Optic Coherence Tomography, and Heidelberg Retinal Tomography

• Yoon JY
• Na JK
• Park CK

• KMID: 2360135
• DOI: http://doi.org/10.3341/kjo.2015.29.1.31

Abstract

PURPOSE
We compared the abilities of Stratus optical coherence tomography (OCT), Heidelberg retinal tomography (HRT) and standard automated perimetry (SAP) to detect the progression of normal tension glaucoma (NTG) in patients whose eyes displayed localized retinal nerve fiber layer (RNFL) defect enlargements.
METHODS
One hundred four NTG patients were selected who met the selection criteria: a localized RNFL defect visible on red-free fundus photography, a minimum of five years of follow-up, and a minimum of five reliable SAP, Stratus OCT and HRT tests. Tests which detected progression at any visit during the 5-year follow-up were identified, and patients were further classified according to the state of the glaucoma using the mean deviation (MD) of SAP. For each test, the overall rates of change were calculated for parameters that differed significantly between patients with and without NTG progression.
RESULTS
Forty-seven (45%) out of 104 eyes displayed progression that could be detected by red-free fundus photography. Progression was detected in 27 (57%) eyes using SAP, 19 (40%) eyes using OCT, and 17 (36%) eyes using HRT. In early NTG, SAP detected progression in 44% of eyes, and this increased to 70% in advanced NTG. In contrast, OCT and HRT detected progression in 50 and 7% of eyes during early NTG, but only 30 and 0% of eyes in advanced NTG, respectively. Among several parameters, the rates of change that differed significantly between patients with and without progression were the MD of SAP (p = 0.013), and the inferior RNFL thickness (p = 0.041) and average RNFL thickness (p = 0.032) determined by OCT.
CONCLUSIONS
SAP had a higher detection rate of NTG progression than other tests, especially in patients with advanced glaucoma, when we defined progression as the enlargement of a localized RNFL defect. The rates of change of the MD of SAP, inferior RNFL thickness, and average RNFL thickness differed between NTG patients with and without progression.

Keyword

Glaucoma progression; Heidelberg retinal tomography; Low tension glaucoma; Optical coherence tomography; Standard automated perimetry

MeSH Terms

Disease Progression
Female
Humans
Intraocular Pressure/*physiology
Low Tension Glaucoma/*diagnosis/physiopathology
Male
Middle Aged
Retina/*pathology
Tomography, Optical Coherence/*methods
Visual Field Tests/*methods
Visual Fields/*physiology

Figure

• 

  Fig. 1 Detection rate of progression by each diagnostic test in 47 patients having an eye with normal tension glaucoma that displayed progression, defined as enlargement of a localized retinal nerve fiber layer defect on red-free fundus photography. SAP = standard automated perimetry; HRT = Heidelberg retinal tomography; OCT = optical coherence tomography.

• 

  Fig. 2 Comparison of methods for detecting disease progression. Sample included 47 patients with normal tension glaucoma who were assessed for enlargement of the localized retinal nerve fiber layer by red-free fundus photography. Data shows detecting disease progression according to glaucoma severity (A, mild glaucoma; B, moderate glaucoma; C, severe glaucoma). MD = mean deviation; SAP = standard automated perimetry; OCT = optical coherence tomography; HRT = Heidelberg retinal tomography.

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