Detecting Progression in Patients with Different Clinical Presentations of Primary Open-angle Glaucoma.

PRCIS Glaucoma progression was more frequently identified by assessing retinal fiber layer thickness than by monitoring visual field loss for different baseline classifications in primary open-angle glaucoma. PURPOSE To compare the detection of glaucoma progression by retinal nerve fiber layer thickness (RNFLT) and visual field (VF) assessments for different baseline classifications of primary open-angle glaucoma (POAG). METHODS This study included 194 eyes from 194 patients with a minimum of 9 follow-up visits selected from the Diagnostic Innovation in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Each eye was classified according to baseline clinical signs: ocular hypertension (OHT, n = 39), glaucomatous optic neuropathy only (GON, n = 60), glaucomatous VF loss only (GVF, n = 39) and definite glaucoma (concurrent optic disc and VF defect, n = 56). We assessed progression by performing simple linear regression on global and sectorial mean deviations values generated for RNFLT (RNFLT-MD) and VF data (VF-MD). The proportion of eyes identified as progressing (positive rate) by RNFLT-MD and by VF-MD were compared within each classification. RESULTS Whereas both parameters performed similarly among GON and definite glaucoma eyes, the positive rate obtained with global RNFLT-MD was significantly greater compared to global VF-MD by 33.3% and 30.8% among OHT eyes and GVF eyes, respectively. This finding was consistent in the infero-temporal sector; however, similar positive rates were obtained for both parameters in the supero-temporal sector. CONCLUSIONS While both parameters showed comparable abilities to identify progression across the different classifications, RNFLT assessment may be better suited to monitor progression, particularly among patients with elevated intraocular pressure and those who present with only glaucomatous VF defect at baseline.