title: Retinal nerve fiber layer atrophy is associated with visual field loss over time in glaucoma suspect and glaucomatous eyes.
abstract: OBJECTIVE
  To compare prospectively detection of progressive retinal nerve fiber layer thickness (RNFL) atrophy identified using time-domain optical coherence tomography with visual field progression using standard automated perimetry in glaucoma suspect and preperimetric glaucoma patients or perimetric glaucoma patients.
  
  
  METHODS
  Prospective, longitudinal clinical trial.
  
  
  METHODS
  Eligible eyes with 2 years or more of follow-up underwent time-domain optical coherence tomography and standard automated perimetry every 6 months. The occurrence of visual field progression was defined as the first follow-up visit reaching a significant (P < .05) negative visual field index slope over time. RNFL progression or improvement was defined as a significant negative or positive slope over time, respectively. Specificity was defined as the number of eyes with neither progression nor improvement, divided by the number of eyes without progression. Cox proportional hazard ratios were calculated using univariate and multivariate models with RNFL loss as a time-dependent covariate.
  
  
  RESULTS
  Three hundred ten glaucoma suspect and preperimetric glaucoma eyes and 177 perimetric glaucoma eyes were included. Eighty-nine eyes showed visual field progression and 101 eyes showed RNFL progression. The average time to detect visual field progression in those 89 eyes was 35 ± 13 months, and the average time to detect RNFL progression in those 101 eyes was 36 ± 13 months. In multivariate Cox models, average and superior RNFL losses were associated with subsequent visual field index loss in the entire cohort (every 10-μm loss; hazard ratio, 1.38; P = .03; hazard ratio, 1.20; P = .01; respectively). Among the entire cohort of 487 eyes, 42 had significant visual field index improvement and 55 had significant RNFL improvement (specificity, 91.4% and 88.7%, respectively).
  
  
  CONCLUSIONS
  Structural progression is associated with functional progression in glaucoma suspect and glaucomatous eyes. Average and superior RNFL thickness may predict subsequent standard automated perimetry loss.
authors.affiliation: Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida, USA.
authors.forename: Mitra
authors.initials: M
authors.lastname: Sehi
authors.forename: Xinbo
authors.initials: X
authors.lastname: Zhang
authors.forename: David S
authors.initials: DS
authors.lastname: Greenfield
authors.forename: Yunsuk
authors.initials: Y
authors.lastname: Chung
authors.forename: Gadi
authors.initials: G
authors.lastname: Wollstein
authors.forename: Brian A
authors.initials: BA
authors.lastname: Francis
authors.forename: Joel S
authors.initials: JS
authors.lastname: Schuman
authors.forename: Rohit
authors.initials: R
authors.lastname: Varma
authors.forename: David
authors.initials: D
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D001369:Axons / Q000473:pathology*; D063171:Corneal Pachymetry; D018450:Disease Progression; D005260:Female; D005901:Glaucoma / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012165:Retinal Ganglion Cells / Q000473:pathology*; D013997:Time Factors; D041623:Tomography, Optical Coherence; D014065:Tonometry, Ocular; D014786:Vision Disorders / Q000175:diagnosis*; D058609:Visual Field Tests; D014794:Visual Fields