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Abstract #104736 Published in IGR 23-2
Predicting Visual Field Progression by Optical Coherence Tomography Angiography and Pattern Electroretinography in Glaucoma
Lee MY; Park HL; Kim SA; Jung Y; Park CKJournal of Glaucoma 2022; 31: 881-890
PRECIS: Reduced P50-N95 amplitude on pattern electroretinography and the presence of microvasculature dropout on optical coherence tomography angiography at baseline were significant factors associated with visual field progression in predominantly normal-tension glaucoma patients. OBJECTIVE: We investigated the baseline demographics and ocular characteristics that predict future progression in glaucoma patients, including pattern electroretinography (PERG) and optical coherence tomography angiography (OCT-A) parameters. METHODS: Hundred and forty eyes with open-angle glaucoma that were prospectively enrolled and followed-up for at least 3 years, and underwent at least five serial visual field (VF) tests were included. Baseline PERG was performed, and N35, P50, and N95 latencies and amplitudes were obtained. Superficial vessel density (VD) at the macula and complete loss of microvasculature within the deep retinal layer of the parapapillary region (microvasculature dropout, MvD) were evaluated from baseline OCT-A images. Eyes with a glaucomatous VF defect in either both hemifields within 24 points of a central 10° of fixation, and with no VF abnormality in the nasal periphery outside 10° of fixation, were considered to have isolated central scotoma. During follow-up, detected disc hemorrhage (DH) was recorded. Parameters associated with VF progression were determined using linear regression analysis of the mean deviation (MD) values, in combination with an event-based analysis using the Glaucoma Progression Analysis (GPA) software from the Humphrey Field Analyzer. "Likely progression" using GPA was considered to have glaucoma progression. RESULTS: Of the 140 eyes, 107 (76.4%) were normal-tension glaucoma (NTG) and 57 (40.7%) exhibited glaucoma progression as defined by Humphrey VF GPA. The MD slopes were -0.43±1.11 dB/y in the progressors and 0.59±1.27 dB/y in the non-progressors (P<0.001). Glaucoma patients with progression showed frequent MvD on OCT-A, isolated central scotoma, frequent DH, and reduced baseline P50-N95 amplitude compared to patients without progression. Age at diagnosis (P=0.038) and baseline P50-N95 amplitude (P=0.019) showed significant associations with the MD slope. The presence of MvD on OCT-A (P<0.001) and baseline P50-N95 amplitude (P=0.037) were significantly associated with VF progression on GPA. CONCLUSIONS: The presence of MvD and RGC dysfunction by PERG at baseline, DH or central scotoma were significant factors associated with VF progression in predominantly NTG patients. These patients should be monitored more closely.
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