Macular OCT Imaging in Glaucoma
Transcript of Macular OCT Imaging in Glaucoma
Macular OCT Imaging in Glaucoma
Kouros Nouri-Mahdavi, MD, MScAssociate Professor of Ophthalmology
Director, Glaucoma Advanced Imaging LaboratoryStein Eye Institute, UCLA
8th World Glaucoma CongressMarch 27-30, 2019
Melbourne, Australia
Financial Disclosures
• I have the following financial interests or relationships to disclose:– Departmental grant from Research to Prevent Blindness– UCLA Innovation Award 2019– Heidelberg Engineering: Lecture Fees, Grant Support, Hardware and Software Support– Aerie: Ad hoc Advisory Board
Full macular thickness
FMT
Ganglion cell complexGCC
Ganglion cell/inner plexiform layersGC/IPL
Ganglion cell layerGCL
Macular Outcome Measures
Mean baseline MD: -14.3 (±5.5)
Criterion 1 Disc Photos Criterion 2 VFI
Stable Progressed Undetermined P Stable Progressed P
Macular thickness (μm/yr) −0.53 ± 1.44 −4.74 ± 4.40 −2.72 ± 4.75 0.01 −2.22 ± 4.33 −5.12 ± 2.40 0.039
RNFL thickness (μm/yr) −0.33 ± 1.29 −1.19 ± 2.62 −1.21 ± 2.75 0.314 −0.90 ± 2.42 −2.08 ± 2.85 0.459
Glaucoma Progression: RNFL vs. Macular Rates of Progression
Table Reproduced from
Sung KR, Sun JH, Na JH, et al. Progression detection capability of macularthickness in advanced glaucomatous eyes. Ophthalmology 2012; 119:308–313.
Glaucoma Progression: RNFL vs. Full Macular Thickness Event Analysis
Lee et al IOVS 2013 (90% NTG eyes)
average cpRNFLT vs.1 sector in TMT
1 quadrant in cpRNFLT vs. 1 sector in TMT
Add Belghhith here
Advanced glaucoma defined as visual field MD < -21 dB
Belghith et al. IOVS 2016
Improving ImprovingWorse Worse
RNFL GCIPL
80-year old F with POAG, IOPs <15 on maximal treatment
2011
2015
Follow-up – baseline thickness
Case Review
Patterns of Progressive GCIPL Thinning in Glaucoma
Baseline distribution of damage Distribution of progression
Shin JW et al. Ophthalmology 2018
Widening of GCIPL defects: 58% • Deepening of defects: 26%• Newly developed GCIPL defects: 21%
Correspondence of Superpixels and 10-2 Test Locations
3
2
1
Central 18 degrees
Macular superpixels
10-2 test locations
Miraftabi et al. TVST 2016
Within-Session Variability < 3 µm
or GCL
All Macular Outcomes: Very Low Local Within-Session Variability
a C
b
3
2
1
Nouri-Mahdavi et al. ARVO 2017
Within-Eye ModelingCentral 18 degrees
Macular superpixels
10-2 testlocations
Does Baseline Thickness Affect Rates of Change?
Regress superpixel thickness against time: FMT, GCC, GCIPL, GCL
Prop
ortio
n of
neg
ativ
e ra
tes (
%)
Baseline Thickness, DecilesThinner Thicker
Proportion of Significant Negative Rates vs. Baseline Thickness
Does Structural Worsening Precede Functional Worsening in Established Glaucoma?
Mohammadzadeh et al.
The Case of Patty B.
• 89 yo F with advanced glaucoma OD• IOPs in low 20s before Trab + MMC• BCVA before surgery: 20/50+2
• BCVA after surgery: 20/80
Mohammadzadeh, Galian, Martinyan, and Nouri-Mahdavi, J Glaucoma 2019
Summary Remarks: Macular OCT Imaging
• Complementary to ONH/RNFL imaging
• Useful for the entire spectrum of glaucoma incl. early glaucoma
• Detection of disease: GCC = GCIPL = GCL
• Excellent reproducibility profile
• Early supporting evidence regarding detection of progression
• GCC: ?optimal outcome measure for monitoring glaucoma at all stages
Detection of Glaucoma
• GCC and GC/IPL > FMT for detection of glaucoma• GCC = GCIPL = GCL• Sectoral GC/IPL (or GCC) better than global measures
Detection of Glaucoma
• GCC and GC/IPL > FMT for detection of glaucoma• GCC = GCIPL = GCL• Sectoral GC/IPL (or GCC) better than global measures• RNFL and macular imaging provide complementary information!
– Combining OCT parameters improves performance!
Adopted from Tan et al. Ophthalmology 2009
Perimetric glaucoma Preperimetric glaucoma
65%13% 9% 33%12% 11%
None: 13% None: 45%
RNFL GCC RNFL GCC