What Are the Factors Associated with the Structural Damage Differences in Open-Angle Glaucoma? RNFL- and GCIPL-Dominant Progression

We sought to analyze the parameters associated with retinal nerve fiber layer (RNFL)-dominant progression or ganglion cell–inner plexiform layer (GCIPL)-dominant progression in patients with open-angle glaucoma. A prospective observational study was conducted. Overall, 58 eyes from 33 patients with open-angle glaucoma were categorized into the following two groups: patients with RNFL- and GCIPL-dominant progression, and the primary outcome was the difference in associated factors between two groups. Higher pre-treatment and mean IOP, greater lamina cribrosa curvature index (LCCI), and younger age were more significantly associated with the RNFL-dominant progression group than the GCIPL-dominant progression group. When adjusting for mean IOP, age, LCCI, and microvascular dropout (MVD), only pre-treatment IOP was significantly associated with the RNFL-dominant progression group. However, when adjusting for pre-treatment IOP, age, LCCI, and MVD, both higher mean IOP and greater LCCI were significantly associated with RNFL-dominant progression. In conclusion, pre-treatment and mean IOP and LCCI were more strongly associated with the RNFL-dominant progression group than the GCIPL-dominant progression group. In contrast, age, peripapillary choroidal microvascular dropout, and systolic and diastolic blood pressures tended to damage the GCIPL predominantly rather than the RNFL. Therefore, our findings suggest the potential to set different treatment targets and identify various treatment methods for each group.