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July 02, 2013
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Confocal scanning laser ophthalmoscopy identifies potential markers of POAG genesis

Assessing the rate of structural change with confocal scanning laser ophthalmoscopy may aid the management of ocular hypertension, according to a study.

Perspective from Douglas J. Rhee, MD

The Confocal Scanning Laser Ophthalmoscopy Ancillary Study to the Ocular Hypertension Treatment Study included 832 eyes of 441 subjects.

Investigators compared the rate of topographic change in 66 eyes of 52 subjects who developed primary open-angle glaucoma (POAG) with the rate of change in 766 eyes of 389 subjects who did not develop POAG.

The Heidelberg Retina Tomograph (Heidelberg Engineering) was used to assess rates of topographic change. Visual fields and stereoscopic optic disc photographs were also evaluated.

The rate of rim area change was significantly faster in each of six rim area regions in POAG eyes compared with non-glaucomatous eyes (P < .05).

The rate of rim area loss and other topographic parameters was significantly faster in eyes with worse baseline visual fields and higher IOP during follow-up.

Statistically significant rates of rim area decrease were also found in non-POAG eyes.

Changes in retinal nerve fiber layer thickness and cross-sectional area were not significantly faster in POAG eyes than in non-POAG eyes.

Perspective

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Douglas J. Rhee, MD
Douglas J. Rhee, MD
This report from the Confocal Scanning Laser Ophthalmoscopy Ancillary Study of the OHTS study provides a great insight into the clinical course of structural changes of the optic nerve neuroretinal rim. Interestingly, the study found a defined rate of progression, or loss, in eyes that had not yet converted to glaucoma by the study’s endpoint. This is consistent with previous literature showing that there is a progressive, albeit slow, rate of ganglion cell loss as a result of aging in normal eyes. This has very important ramifications for patients with very advanced glaucomatous disease that is continuing to progress despite an IOP within the target range. Specifically, the progression may simply be the result of aging rather than the pathophysiologic consequence of glaucoma; in other words, just because we lower the IOP, it doesn’t stop the natural aging process. Additionally, the elucidation of a more-rapid progression in eyes that eventually converted to glaucoma from ocular hypertension may be a very important clinical means to diagnose primary open-angle glaucoma earlier.
Douglas J. Rhee, MD
OSN Glaucoma Board Member
Disclosures: Rhee has no relevant financial disclosures.
Sources/Disclosures

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Source:

Am J Ophthalmol. 2013;155(6):971-982.