Elsevier

American Journal of Ophthalmology

Volume 245, January 2023, Pages 184-192
American Journal of Ophthalmology

Original Articles
Effect of Testing Frequency on the Time to Detect Glaucoma Progression With Optical Coherence Tomography (OCT) and OCT Angiography

https://doi.org/10.1016/j.ajo.2022.08.030Get rights and content

PURPOSE

To determine how the frequency of testing affects the time required to detect statistically significant glaucoma progression for circumpapillary retinal nerve fiber layer (cpRNFL) with optical coherence tomography (OCT) and circumpapillary capillary density (cpCD) with OCT angiography (OCTA).

DESIGN

Retrospective, observational cohort study.

METHODS

In this longitudinal study, 156 eyes of 98 patients with glaucoma followed up over an average of 3.5 years were enrolled. Participants with 4 or more OCT and OCTA tests were included to measure the longitudinal rates of cpRNFL thickness and cpCD change over time using linear regression. Estimates of variability were then used to re-create real-world cpRNFL and cpCD data by computer simulation to evaluate the time required to detect progression for various loss rates and different testing frequencies.

RESULTS

The time required to detect a statistically significant negative cpRNFL and cpCD slope decreased as the testing frequency increased, albeit not proportionally. cpCD detected progression slightly earlier than cpRNFL. Eighty percent of eyes with a cpCD loss of −1%/y were detected after 6.0, 4.2, and 4 years when testing was performed 1, 2, and 3 times per year, respectively. Progression in 80% of eyes with a cpRNFL loss of −1 µm/y was detected after 6.3, 5.0, and 4.2 years, respectively.

CONCLUSIONS

cpRNFL and cpCD are comparable in detecting progression. As there were only small changes in the time to detect progression when testing increased from 2 to 3 times per year, testing twice per year may provide sufficient information for detecting progression with either OCT or OCTA in clinical settings.

Section snippets

PARTICIPANTS

This longitudinal study includes primary open angle glaucoma patients enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS)25,26 who underwent both OCT and OCTA testing. Institutional review board approval was obtained, and written informed consent was acquired from all participants. This study adhered to the tenets of the Declaration of Helsinki and was conducted in accordance with the Health Insurance Portability and Accountability Act.

Inclusion criteria include (1) diagnosis of

RESULTS

This study included 156 eyes of 98 patients with a mean (95% CI) baseline age of 68.6 (66.8, 70.4) years over a mean (95% CI) follow-up time of 3.5 (3.4, 3.6) years. A total of 21 eyes were excluded because of poor image quality. One-hundred twenty-seven eyes (81.4%) had early glaucoma at baseline with MD better than −6.0 dB, and 29 eyes (18.6%) had moderate to advanced VF loss (MD worse than −6 dB). The patients were seen over a mean (95% CI) of 5.3 (5.1, 5.5) visits. At the first visit, the

DISCUSSION

This study evaluated the time required to detect OCT and OCTA progression in glaucoma eyes using different rates of cpCD and cpRNFL loss with respect to various frequencies of testing per year. We also provided information on how frequently testing should be performed to detect different rates of loss. With a similar frequency of testing, cpCD detected progression slightly sooner than cpRNFL. cpRNFL and cpCD were comparable and complementary in detecting glaucoma progression over time. Two

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    Supplemental Material available at AJO.com.

    1

    Golnoush Mahmoudinezhad and Sasan Moghimi had equal contributions as co–first authors.

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