title: The rate of structural change: the confocal scanning laser ophthalmoscopy ancillary study to the ocular hypertension treatment study.
abstract: OBJECTIVE
  To compare rates of topographic change in ocular hypertensive eyes that develop primary open-angle glaucoma (POAG) compared to eyes that do not, and to identify factors that influence the rate of change.
  
  
  METHODS
  Longitudinal, randomized clinical trial.
  
  
  METHODS
  Four hundred forty-one participants (832 eyes) in the Confocal Scanning Laser Ophthalmoscopy Ancillary Study to the Ocular Hypertension Treatment Study were included. POAG was defined as repeatable visual field, photography-based optic disc changes, or both. The rate of topographic change in the 52 participants (66 eyes) who developed POAG was compared with that of participants who did not develop POAG using multivariable mixed effects models.
  
  
  RESULTS
  In both univariate and multivariate analyses, the rate of rim area loss was significantly faster in eyes in which POAG developed than in eyes in which it did not (univariate mean, -0.0131 mm(2)/year and -0.0026 mm(2)/year, respectively). The significantly faster rate of rim area loss in black persons found in the univariate analysis did not remain significant when baseline disc area was included in the model. In multivariate analyses, the rate of rim area loss and other topographic parameters also was significantly faster in eyes with worse baseline visual field pattern standard deviation and higher intraocular pressure during follow-up. Moreover, a significant rate of rim area loss was detected in eyes in which POAG did not develop (P < .0001). The rate of rim area loss in eyes with an optic disc POAG endpoint was significantly faster than in those with a visual field POAG endpoint.
  
  
  CONCLUSIONS
  The rate of rim area loss is approximately 5 times faster in eyes in which POAG developed compared with eyes in which it did not. These results suggest that measuring the rate of structural change can provide important information for the clinical management of ocular hypertensive patients. Additional follow-up is needed to determine whether the statistically significant change in the eyes in which POAG did not develop represents normal aging or glaucomatous change not detected by conventional methods.
authors.affiliation: Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California 92093-0946, USA. lzangwill@ucsd.edu
authors.forename: Linda M
authors.initials: LM
authors.lastname: Zangwill
authors.forename: Sonia
authors.initials: S
authors.lastname: Jain
authors.forename: Keri
authors.initials: K
authors.lastname: Dirkes
authors.forename: Feng
authors.initials: F
authors.lastname: He
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Medeiros
authors.forename: Gary L
authors.initials: GL
authors.lastname: Trick
authors.forename: James D
authors.initials: JD
authors.lastname: Brandt
authors.forename: George A
authors.initials: GA
authors.lastname: Cioffi
authors.forename: Anne L
authors.initials: AL
authors.lastname: Coleman
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Liebmann
authors.forename: Jody R
authors.initials: JR
authors.lastname: Piltz-Seymour
authors.forename: Mae O
authors.initials: MO
authors.lastname: Gordon
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kass
authors.forename: Robert N
authors.initials: RN
authors.lastname: Weinreb
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D018450:Disease Progression; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009798:Ocular Hypertension / Q000175:diagnosis / Q000188:drug therapy; D009887:Ophthalmoscopy / Q000379:methods; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000188:drug therapy; D010781:Photography; D012165:Retinal Ganglion Cells / Q000473:pathology*; D014794:Visual Fields / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents