Longitudinal Macular Structure-Function Relationships in Glaucoma and Their Sources of Variability

• Published in: American journal of ophthalmology Vol. 207; pp. 18 - 36
• Main Authors: Nouri-Mahdavi, Kouros, Fatehi, Nima, Caprioli, Joseph
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2019; Elsevier Limited
• Subjects: Adult; Aged; Cross-Sectional Studies; Ethnicity; Female; Follow-Up Studies; Glaucoma; Glaucoma - diagnosis; Glaucoma - physiopathology; Humans; Intraocular Pressure - physiology; Investigations; Macula Lutea - pathology; Macula Lutea - physiopathology; Male; Middle Aged; Ophthalmology; Prospective Studies; Retinal Ganglion Cells - pathology; Sensory Thresholds - physiology; Tomography; Tomography, Optical Coherence - methods; Visual Acuity; Visual Field Tests; Visual Fields - physiology
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2019.04.034

To review central structure-function (SF) relationships in glaucoma; to compare contributions of within-session and between-session variability to total variability of macular optical coherence tomography (OCT) thickness measurements; and to test the hypothesis that longitudinal within-eye variability of central SF relationships is smaller than between-individual variability. We reviewed the pertinent literature on central SF relationships in glaucoma. Thirty-eight eyes (20 normal or glaucoma subjects) had ×3 macular images per session over 3 sessions, and superpixels thickness measurements for ganglion cell layer (GCL), ganglion cell/inner plexiform layer (GCIPL), ganglion cell complex (GCC), and full macular thickness (FMT) were exported. Linear mixed models were used for estimating contributions of between- and within-session variability to total thickness variability. One hundred twenty eyes with ≥3 10° visual fields (VFs)/OCT images were enrolled for the longitudinal study. We investigated within-eye longitudinal SF relationships (GCIPL thickness vs VF total deviations) with a change-point regression model and compared within-eye to between-individual variabilities with components-of-variance models. In the cross-sectional study, the between-session component contributed 8%, 11%, 11%, and 36% of total variability for GCL, GCIPL, GCC, and FMT, respectively. In the longitudinal study, between-individual variability explained 78%, 77%, and 67% of total SF variability at 3.4°, 5.6°, and 6.8° eccentricities, respectively (P < .05). SF relationships remained stable over time within individual eyes. Within-session variability accounts for most of macular thickness variability over time. Longitudinal within-eye SF variability is smaller than between-individual variability. Study of within-eye SF relationships could help clinicians better understand SF linking in glaucoma and help refine progression algorithms. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.