Comparative analysis of methods in detecting glaucomatous progression

• Published in: Acta ophthalmologica (Oxford, England) England), 2025-01, Vol.103 (S284), p.n/a
• Main Authors: Fernandez‐Velasco, Diego, Mallen, Victor, Bermudez, Javier, Biescas, Andrés, Rius, Nuria, Ila, Carmen, Monleón, Claudia Hernández‐Barahona, Navarro, Damián García, Santana, Carlos, Munuera, Inés
• Format: Article
• Language: English
• Subjects: Comparative analysis; Glaucoma; Optic nerve; Optic neuropathy; Optics; Retinal ganglion cells; Sensitivity analysis; Structure-function relationships; Tomography; Visual field
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/aos.17091

Aims/Purpose: Glaucoma is an optic neuropathy that, if left untreated, leads to irreversible blindness, making reliable methods for detecting progression essential. Functional damage is assessed by the reduction of the visual field (VF), and structural damage is evaluated by the thinning of retinal parameters. Since 50% of ganglion cells are located in the macular area, their study could be a good indicator of progression. The objective of this work is to evaluate the utility of ganglion cell layer (GCL) analysis using optical coherence tomography (OCT) in diagnosing glaucoma progression. Methods: This is a retrospective cross‐sectional study including 205 eyes with glaucoma followed for at least three years. The progression analysis values obtained from OCT of the GCL and the optic nerve fiber layer (NFL) are compared, taking the VF as a reference and stratifying by severity into mild and moderate‐advanced glaucoma. Results: In mild glaucoma, VF has limitations because functional damage does not occur until there is a 20‐40% loss of ganglion cells. Structural tests classify more cases as progression, and the concordance between them is higher than with VF. OCT of the GCL is the test that classifies progression the most. In moderate‐advanced glaucoma, VF classifies more cases than in mild glaucoma. However, VF is a variable test, influenced by the learning effect, and when damage is very advanced, results can be erroneous because the retina loses sensitivity. OCT of the NFL classifies fewer cases than in mild glaucoma because debris creates a floor effect that artifacts the measurement. OCT of the GCL is the test that classifies progression the most. The concordance is greater between OCT of the GCL and VF. Conclusions: In conclusion, OCT of the GCL may be a better indicator of progression than NFL in both mild and moderate‐advanced glaucoma. It could be a useful strategy in clinical practice for diagnosing glaucomatous progression. References Munuera I, Gándara‐Rodriguez de Campoamor E, Moreno‐Montañes J. Study of the ganglion cell complex of the macula by optical coherence tomography in the diagnosis of glaucoma progression. Arch Soc Esp Oftalmol (Engl Ed). 2024 Apr;99(4):145‐151.