Ganglion Cell Complex: The Optimal Measure for Detection of Structural Progression in the Macula.
Vahid Mohammadzadeh, Erica Su, Alessandro Rabiolo, Lynn Shi, Sepideh Heydar Zadeh, Simon K Law, Anne L Coleman, Joseph Caprioli, Robert E Weiss, Kouros Nouri-Mahdavi
Author Information
Vahid Mohammadzadeh: From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (V.M., L.S., S.H.Z., S.K.L., A.L.C., J.C., K.N.M.).
Erica Su: Department of Biostatistics, Fielding School of Public Health (E.S., R.E.W.).
Alessandro Rabiolo: University of California-Los Angeles, Los Angeles, California and; Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK (A.R.).
Lynn Shi: From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (V.M., L.S., S.H.Z., S.K.L., A.L.C., J.C., K.N.M.).
Sepideh Heydar Zadeh: From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (V.M., L.S., S.H.Z., S.K.L., A.L.C., J.C., K.N.M.).
Simon K Law: From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (V.M., L.S., S.H.Z., S.K.L., A.L.C., J.C., K.N.M.).
Anne L Coleman: From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (V.M., L.S., S.H.Z., S.K.L., A.L.C., J.C., K.N.M.).
Joseph Caprioli: From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (V.M., L.S., S.H.Z., S.K.L., A.L.C., J.C., K.N.M.).
Robert E Weiss: Department of Biostatistics, Fielding School of Public Health (E.S., R.E.W.).
Kouros Nouri-Mahdavi: From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (V.M., L.S., S.H.Z., S.K.L., A.L.C., J.C., K.N.M.). Electronic address: nouri-mahdavi@jsei.ucla.edu.
PURPOSE: To test the hypothesis that macular ganglion cell complex (GCC) thickness from optical coherence tomography (OCT) provides a stronger change signal regardless of glaucoma severity compared with other macular measures. DESIGN: Prospective cohort study. METHODS: Eyes were from 112 patients with moderate to severe glaucoma at baseline from a tertiary glaucoma center. In each 3° × 3° macular superpixel, a hierarchical Bayesian random intercept and slope model with random residual variance was fit to longitudinal full macular thickness (FMT), outer retina layers, GCC, ganglion cell-inner plexiform layer (GCIPL), and ganglion cell layer (GCL) measurements. We estimated population- and individual-level slopes and intercepts. Proportions of substantial worsening and improving superpixel slopes were compared between layers and in superpixels with mild to moderate vs severe damage (total deviation of corresponding visual field location ≥ -8 vs < -8 dB). RESULTS: Mean (SD) follow-up time and baseline 10-2 visual field mean deviation were 3.6 (0.4) years and -8.9 (5.9) dB, respectively. FMT displayed the highest proportion of significant negative slopes (1932/3519 [54.9%]), followed by GCC (1286/3519 [36.5%]), outer retina layers (1254/3519 [35.6%]), (GCIPL) (1075/3518 [30.6%]), and (GCL) (698/3518 [19.8%]). Inner macular measures detected less worsening in the severe glaucoma group; yet GCC (223/985 [22.6%]) identified the highest proportion (GCIPL: 183/985 [18.6%]; GCL: 106/985 [10.8%]). Proportions of positive rates were small and comparable among all measures. CONCLUSIONS: GCC is the optimal macular measure for detection of structural change in eyes with moderate to severe glaucoma. Although a higher proportion of worsening superpixels was observed for FMT, a large portion of FMT change could be attributed to changes in outer retina layers.
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