Purpose

To investigate rates of structural and functional change in a large clinical population of glaucoma and glaucoma suspect patients.

Design

Retrospective cohort.

Methods

Twenty-nine thousand five hundred forty-eight spectral-domain optical coherence tomography (OCT) and 19,812 standard automated perimetry (SAP) tests from 6138 eyes of 3669 patients with ≥6 months of follow-up, 2 good quality spectral-domain OCT peripapillary retinal nerve fiber layer scans, and 2 reliable SAP tests were included. Data were extracted from the Duke Glaucoma Registry, a large database of electronic health records of patients from the Duke Eye Center and satellite clinics. Rates of change for the 2 metrics were obtained using linear mixed models, categorized according to pre-established cutoffs, and analyzed according to the severity of the disease.

Results

Average rates of change were −0.73 ± 0.80 μm per year for global retinal nerve fiber layer thickness and −0.09 ± 0.36 dB per year for SAP mean deviation. More than one quarter (26.6%) of eyes were classified as having at least a moderate rate of change by spectral-domain OCT vs 9.1% by SAP (P < .001). In eyes with severe disease, 31.6% were classified as progressing at moderate or faster rates by SAP vs 26.5% by spectral-domain OCT (P = .055). Most eyes classified as fast by spectral-domain OCT were classified as slow by SAP and vice versa.

Conclusion

Although most patients under routine care had slow rates of progression, a substantial proportion had rates that could potentially result in major losses if sustained over time. Both structural and functional tests should be used to monitor glaucoma, and spectral-domain OCT still has a relevant role in detecting fast progressors in advanced disease.

中文翻译：

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大量临床人群的青光眼结构和功能变化率：杜克青光眼登记研究。

目的

调查大量青光眼和青光眼疑似患者临床人群的结构和功能变化率。

设计

回顾性队列。

方法

29548 次光谱域光学相干断层扫描 (OCT) 和 19,812 次标准自动视野检查 (SAP) 测试来自 3669 名患者的 6138 只眼，随访时间≥6 个月，2 次优质光谱域 OCT 视乳头周围包括视网膜神经纤维层扫描和 2 次可靠的 SAP 测试。数据提取自杜克青光眼登记处，这是一个包含杜克眼科中心和卫星诊所患者电子健康记录的大型数据库。使用线性混合模型获得 2 个指标的变化率，根据预先确定的临界值进行分类，并根据疾病的严重程度进行分析。

结果

全球视网膜神经纤维层厚度的平均变化率为每年-0.73 ± 0.80 μm，SAP 平均偏差为每年 -0.09 ± 0.36 dB。超过四分之一 (26.6%) 的眼睛被归类为光谱域 OCT 至少具有中等变化率，而 SAP 为 9.1% ( P < .001)。在患有严重疾病的眼睛中，SAP 将 31.6% 的患者分类为中等或更快的进展率，而光谱域 OCT 将 26.5% 分类为进展率 ( P  = .055)。大多数被光谱域 OCT 归类为快的眼睛被 SAP 归类为慢，反之亦然。

结论

尽管大多数接受常规护理的患者进展速度较慢，但​​如果随着时间的推移持续下去，很大一部分患者的进展速度可能会导致重大损失。应该使用结构和功能测试来监测青光眼，并且光谱域 OCT 在检测晚期疾病的快速进展者方面仍然具有相关作用。