LAUSR

PURPOSE To investigate rates of structural and functional change in a large clinical population of glaucoma and glaucoma suspect patients. DESIGN Retrospective cohort. METHODS 29,548 spectral-domain optical coherence tomography (SDOCT) and 19,812 standard automated perimetry (SAP) tests from 6,138 eyes of 3,669 patients with at least 6 months of follow-up, 2 good quality SDOCT peripapillary retinal nerve fiber layer (RNFL) and 2 reliable SAP tests were included. Data were extracted from the Duke Glaucoma Registry, a large database of electronic medical records of patients from the Duke Eye Center and satellite clinics. Rates of change for the two metrics were obtained using linear mixed models, categorized according to pre-established cut-offs, and analyzed according to the severity of the disease. RESULTS Average rates of change were -0.73±0.80μm/year for global RNFL thickness and -0.09±0.36dB/year for SAP mean deviation (MD). 26.6% of eyes were classified as having at least a moderate rate of change by SDOCT versus 9.1% by SAP (P<0.001). In eyes with severe disease, 31.6% were classified as progressing at moderate or faster rates by SAP versus 26.5% by SDOCT (P=0.055). Most eyes classified as fast by SDOCT were classified as slow by SAP and vice-versa. CONCLUSION Although most patients under routine care had slow rates of progression, a substantial proportion had rates that could potentially result in major losses if sustained over time. Both structural and functional tests should be used to monitor glaucoma, and SDOCT still has a relevant role in detecting fast progressors in advanced disease.