Comparison of Rates of Progression of Macular OCT Measures in Glaucoma

PURPOSE: The purpose of this study was to compare rates of change of various macular thickness measures and evaluate the influence of baseline damage on macular rates of change. METHODS: One hundred twelve eyes (112 patients) with ≥ 2 years of follow-up and ≥ 5 macular optical coherence tomography (OCT) images and 10-2 visual field (VF) tests were included. OCT measures of interests were full macular thickness (FMT), ganglion cell complex (GCC), ganglion cell/inner plexiform layer (GCIPL), ganglion cell layer (GCL), and outer retinal layer (ORL) thickness in 3° × 3° superpixels. Rates of change were estimated with linear regression and normalized by dividing rates by the average normative superpixel thickness. We compared rates of change and proportion of significantly worsening superpixels (detection rate) and improving superpixels (false discovery rate [FDR]) among macular measures as a function of baseline thickness and 10-2 VF status. RESULTS: Median (interquartile range [IQR]) baseline VF mean deviation, follow-up time, and number of VFs/OCTs were −7.6 dB (−11.8 to −3.8 dB), 4.5 years (4.0–5.0 years), and 9 (8–10), respectively. Normalized FMT and GCC rates of change were faster and detection rates were higher than GCIPL and GCL (P < 0.001), but FMT had lower FDR than GCC (P = 0.02); faster FMT rates were partially explained by ORL rates of change. GCC detection rates were less likely than GCIPL and GCL rates to decrease with diminishing baseline thickness or worse VF damage. In eyes with 10-2 VF worsening, GCC and GCL demonstrated the fastest rates of change. CONCLUSIONS: GCC measurements are most likely to detect structural worsening along the spectrum of glaucoma severity. Although FMT rates of change are least influenced by baseline thickness, they partially reflect likely age-related ORL changes. TRANSLATIONAL RELEVANCE: GCC thickness measurements seem to be the optimal macular outcome measure for detection of glaucoma deterioration.