Program #4162

Rates of retinal nerve fibre layer thickness change from scanning laser polarimetry and
time-domain optical coherence tomography in glaucoma patients and control subjects

N O’Leary, D M Hutchison, P H Artes, M T Nicolela, B C Chauhan

Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada

Purpose Results
To examine rates of change of retinal nerve fibre layer thickness (RNFLT) measurements in Rates of RNFLT Change Case I: control subject OS Case II: glaucoma patient OD
glaucoma patients and healthy, age-similar control subjects with:
- scanning laser polarimetry (SLP) with variable corneal compensation (VCC) and enhanced
corneal compensation (ECC)
- time-domain optical coherence tomography (OCT)
To assess longitudinal RNFLT variability, the potential sources of variability and the power to detect
RNFLT change with each imaging modality.

Methods
Participants
Seventy-five glaucoma patients (Artes PH and Chauhan BC, Prog Retin Eye Res 2005) and 55
control subjects.
Scanning Figure 4. Eye time-series of RNFLT measurements from (a) VCC, (e) ECC, and (i) OCT imaging modalities. Red
Participants were examined with GDx-VCC, GDx- fitted lines indicate statistically significant rates. Panels (b) - (d): VCC images, (f) - (h): ECC images, (j) - (l): OCT
images. Sample examinations indicated by black dots in the time series plots.
ECC and Stratus OCT every 6-months in a Figure 2. Distributions of rates of RNFLT change in glaucoma patients for
longitudinal prospective study (a) VCC series, (b) ECC series and (c) OCT series and in control subjects
for (d) VCC series (e) ECC series and (f) OCT series. Typical Scan Score
Selection Figure 5. Rates of RNFLT change and
Table 2. Median rates of RNFLT change (µm/year) [95% confidence interval]. corresponding rates of TSS change in
One eye of 60 glaucoma patients and 36 control
both glaucoma patients and control
subjects were selected based on the selection Glaucoma Control † statistically significant
subjects for (a) VCC series and (b) ECC
criteria in Figure 1 to obtain good quality, difference between patients
VCC† 0.12 [-0.25, 0.24] -0.12 [-0.45, 0.11] and control subjects series. Spearman’s ρ values for in
sufficiently long image series. (Mann-Whitney U test) patients were -0.46 (p<0.01) and -0.07
ECC† -0.31* [-0.49, -0.14] -0.18* [-0.68, 0.01] * median statistically (p=0.58) for VCC and ECC respectively.
significantly different from 0 Corresponding values in controls were
Table 1. Demographic and baseline measurements. OCT† -0.16 [-0.66, 0.08] 0.74* [0.11, 1.15] (Wilcoxon signed-rank test) -0.19 (p=0.26) and -0.19 (p=0.26).
Glaucoma Control p
Baseline RNFLT and Rates of RNFLT Change Power to Detect Change
Number subjects 60 36
Rates of RNFLT change based on a decrease from median baseline RNFLT measurements in controls
Age at baseline [years] 65.0 (12.4) 62.6 (13.6) 0.60 to those of patients over 10 years and SDRES values were used to model clinically meaningful change
at moderate and high levels of measurement noise in follow-up data. Powers to detect this change over
Male 33 (55%) 14 (39%) 3.5 years (scanning every 6 months) are indicated below.
0.14
VCC Power ECC Power OCT Power
Female 27 (45%) 22 (61%) High Noise : 0.31 High Noise : 0.48 High Noise: 0.60
Moderate Noise : 0.67 Moderate Noise : 0.84 Moderate Noise : 0.80
TSNIT VCC RNFLT [µm] 43.1 (10.7) 52.2 (6.2) <0.001
-2.79 μ/year

TSNIT ECC RNFLT [µm] 39.3 (10.4) 49.4 (5.3) <0.001

Global OCT RNFLT [µm] 71.0 (24.5) 97.8 (9.5) <0.001

-0.91 μ/year -1.02 μ/year
Figure 1. The study selection criteria for analysis of
MD [dB] -3.3 (5.0) 0.0 (2.1) <0.001 scans and series for VCC, ECC and OCT imaging
modalities. Summary of number of eyes in each
Values are median (interquartile range) group and median number of scans and length of
TSNIT: temporal-superior-nasal-inferior-temporal
follow-up for each imaging modality and group are
MD: mean deviation, PSD: pattern standard deviation
shown.
Conclusions
Analysis Figure 3. Rates of global RNFLT change compared to mean RNFLT at Results show a slow rate of RNFLT change in these glaucoma patients (mostly indistinguishable from
baseline in glaucoma patients for (a) VCC series, (b) ECC series and (c)
• Least squares linear regression was used to calculated rates of RNFLT change. OCT series and in control subjects for (d) VCC series (e) ECC series
controls), possibly with most changes having occurred prior to study enrolment.
and (f) OCT series. Series with statistically significant rates of RNFLT The significant difference in rates of change between glaucoma patients and controls in OCT was
• Rates were compared between patients and controls using Mann-Whitney U test. change are highlighted. Spearman’s ρ values: (a) -0.30, (b) -0.13, (c) - mainly due to a spurious finding of increasing RNFL thickness in controls
• Standard deviations of residuals (SDRES) of RNFLT values from fitted lines were used to estimate 0.09, (d) 0.13, (e) 0.21, (f) 0.01.
the longitudinal variability of RNFLT measurements. Rates of change of TSS are strongly correlated with rates of RNFLT change in VCC but not in ECC.

• The relationship between baseline RNFLT to subsequent rates of RNFLT change was examined.
Variability and Image Quality Simple modelling based on measurement variability of these devices shows reasonable power of these
Median SDRES values were 1.1 µm, 1.1 µm and 2.7 µm for VCC, devices to detect clinically meaningful RNFLT change.
• For VCC and ECC, the effects of changes in the atypical nature of retardance measurements,
measured with typical scan score (TSS), on rates of RNFLT change were assessed. ECC and OCT measured RNFLT. QS was weakly predictive of
VCC RNFLT variability in patients (ρ=-0.29, p=0.03) but not in Support
• Image quality (quality score [QS] for VCC and ECC, signal strength [SS] for OCT) was controls and not predictive of ECC RNFLT variability in patients or
investigated as a predictor of RNFLT variability. Grant MOP-11357 from the Canadian Institutes of Health Research (BCC)
controls. SS was not predictive of RNFLT variability in OCT.
Author disclosure block: N. O'Leary, None; D.M. Hutchison, None; P.H. Artes, None; M.T. Nicolela, None; B.C. Chauhan, Heidelberg Engineering, F, Carl Zeiss Meditec, F.