Trend-based analysis of retinal nerve fiber layer thickness measured by optical coherence tomography in eyes with localized nerve fiber layer defects.
OBJECTIVE
To evaluate the rate of change in retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) in eyes with stable and progressive localized RNFL defects and to investigate, in a trend-based approach, the diagnostic capability of OCT in the detection of progressive RNFL thinning.


METHODS
The study included 153 glaucomatous eyes with localized RNFL defects. The patients were divided into nonprogressors (n = 77) and progressors (n = 76) on the basis of an evaluation of serial red-free photographs. The rates of progressive thinning in global, quadrant, and clock-hour OCT RNFL thicknesses were determined, by linear regression, and were compared between groups. Areas under receiver operating characteristic curves and sensitivities at fixed specificities were calculated for each parameter.


RESULTS
The rate of progressive RNFL thinning was significantly faster in progressors than in nonprogressors globally; in the inferior quadrant; in the 10, 11, 6, and 7 o'clock sectors; and in the affected quadrant and clock-hour sector thicknesses (all P ≤ 0.001). The rate of RNFL thinning in affected clock-hour sectors had the highest ability to discriminate between stable and progressive RNFL thinning with a sensitivity of 62% (95% confidence interval, 50%-73%) at a specificity ≥80%. Agreement between OCT and red-free photography was strongest when the criterion of -3.6 μm/year with P < 0.1 was used for each clock hour.


CONCLUSIONS
The rate of OCT RNFL thinning was significantly greater in patients with progressive localized RNFL defects than in those with stable localized defects. The data suggest that trend-based analysis of OCT RNFL thickness may be useful in glaucoma progression analysis and may complement other diagnostic tests.
Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
Eun Ji
EJ
Lee
Tae-Woo
TW
Kim
Robert N
RN
Weinreb
Ki Ho
KH
Park
Seok Hwan
SH
Kim
Dong Myung
DM
Kim
D000886:Anthropometry; D018450:Disease Progression; D005260:Female; D005901:Glaucoma / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000503:physiopathology; D010781:Photography; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology