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  • Predicting RNFL Thinning in Glaucoma

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, November 2018

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    Moghimi et al. investigated potential links between thinning of the retinal nerve fiber layer (RNFL) and baseline vessel density of the mac­ula and optic nerve head (ONH). They hypothesized that the degree of vessel density may predict RNFL thinning of eyes with mild or moderate glaucoma. Their findings suggest that lower macular and ONH vessel density are associated with faster RNFL decline, as measured by spectral-domain optical coherence tomography (SD-OCT).

    For this prospective observational study, 83 patients with mild or moderate primary open-angle glaucoma (132 eyes) received follow-up for at least 2 years (average, 27.3 ± 3.36 months). Measurements of macular whole-image vessel density (m-wiVD) and ONH whole-image vessel density (onh-wiVD) were acquired at baseline, using OCT angiography. Measurements of RNFL thickness, minimum rim width, and ganglion cell plus inner plexiform layer thickness were ob­tained semiannually using SD-OCT. Random-effects models were used to ascertain relationships between vessel density parameters at baseline and the rates of RNFL loss, after adjusting for confounding factors. Outcomes of interest were the effects of m-wiVD and onh-wiVD on rates of RNFL loss.

    The average RNFL thickness at base­line was 79.5 ± 14.8 μm, which declined by a mean slope of –1.07 μm per year. In the univariate model, which includ­ed just a predictive factor and time plus their interaction, each 1% lower m-wiVD and onh-wiVD was associated with a 0.11-μm per year and 0.06-μm per year faster rate of RNFL decline, respectively. A similar relation­ship between low m-wiVD/onh-wiVD and faster rates of RNFL loss was observed with other multivariate models. Nevertheless, in this study, the link between vessel density measure­ments and rate of RNFL loss was weak. In univariate and multivariate analyses, average central corneal thickness pre­dicted faster RNFL decline.

    Eyes with advanced glaucoma were not included in the study because their RNFL is unlikely to undergo rapid change. This research offers new insight for glaucoma management and sup­ports the role of OCT parameters in predicting the risk and rate of glau­coma progression. Macular and ONH vessel density may be specific parame­ters to include in this assessment.

    The original article can be found here.