title: Rates of retinal nerve fiber layer thinning in glaucoma suspect eyes.
abstract: OBJECTIVE
  To compare the rates of retinal nerve fiber layer (RNFL) loss in patients suspected of having glaucoma who developed visual field damage (VFD) with those who did not develop VFD and to determine whether the rate of RNFL loss can be used to predict the development of VFD.
  
  
  METHODS
  Prospective, observational cohort study.
  
  
  METHODS
  Glaucoma suspects, defined as having glaucomatous optic neuropathy or ocular hypertension (intraocular pressure, >21 mmHg) without repeatable VFD at baseline, from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study.
  
  
  METHODS
  Global and quadrant RNFL thickness (RNFLT) were measured with the Spectralis spectral-domain optical coherence tomography (SD-OCT; Spectralis HRA+OCT [Heidelberg Engineering, Heidelberg, Germany]). Visual field damage was defined as having 3 consecutive abnormal visual fields. The rate of RNFL loss in eyes developing VFD was compared to eyes not developing VFD using multivariate linear mixed-effects models. A joint longitudinal survival model used the estimated RNFLT slope to predict the risk of developing VFD, while adjusting for potential confounding variables.
  
  
  METHODS
  The rate of RNFL thinning and the probability of developing VFD.
  
  
  RESULTS
  Four hundred fifty-four eyes of 294 glaucoma suspects were included. The average number of SD-OCT examinations was 4.6 (range, 2-9), with median follow-up of 2.2 years (0.4-4.1 years). Forty eyes (8.8%) developed VFD. The estimated mean rate of global RNFL loss was significantly faster in eyes that developed VFD compared with eyes that did not develop VFD (-2.02 μm/year vs. -0.82 μm/year; P<0.001). The joint longitudinal survival model showed that each 1-μm/year faster rate of global RNFL loss corresponded to a 2.05-times higher risk of developing VFD (hazard ratio, 2.05; 95% confidence interval, 1.14-3.71; P = 0.017).
  
  
  CONCLUSIONS
  The rate of global RNFL loss was more than twice as fast in eyes that developed VFD compared with eyes that did not develop VFD. A joint longitudinal survival model showed that a 1-μm/year faster rate of RNFLT loss corresponded to a 2.05-times higher risk of developing VFD. These results suggest that measuring the rate of SD-OCT RNFL loss may be a useful tool to help identify patients who are at a high risk of developing visual field loss.
authors.affiliation: Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Atsuya
authors.initials: A
authors.lastname: Miki
authors.affiliation: Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California.
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Medeiros
authors.affiliation: Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Weinreb
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California.
authors.forename: Sonia
authors.initials: S
authors.lastname: Jain
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California.
authors.forename: Feng
authors.initials: F
authors.lastname: He
authors.affiliation: Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California.
authors.forename: Lucie
authors.initials: L
authors.lastname: Sharpsten
authors.affiliation: Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California.
authors.forename: Naira
authors.initials: N
authors.lastname: Khachatryan
authors.affiliation: Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California.
authors.forename: Na'ama
authors.initials: N
authors.lastname: Hammel
authors.affiliation: Department of Ophthalmology, New York University School of Medicine, New York, New York; Department of Ophthalmology, Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Liebmann
authors.affiliation: Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Girkin
authors.affiliation: Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Sample
authors.affiliation: Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California. Electronic address: lzangwill@ucsd.edu.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Zangwill
mesh_terms: D001741:Black or African American; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009798:Ocular Hypertension / Q000175:diagnosis*; D009898:Optic Disk / Q000473:pathology*; D011446:Prospective Studies; D012165:Retinal Ganglion Cells / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000175:diagnosis*; D014792:Visual Acuity; D014794:Visual Fields; D044465:White People