Evaluation of Retinal Nerve Fiber Layer Progression in Glaucoma A Comparison between the Fast and the Regular Retinal Nerve Fiber Layer Scans

Objective: To compare the performance of the fast (256 A-scans in each scan circle) and the regular (512 A-scans in each scan circle) retinal nerve fiber layer (RNFL) scan protocols for detection of glaucoma progression using the Stratus optical coherence tomography (OCT) device (Carl Zeiss Meditec, Dublin, CA). Design: Retrospective, longitudinal study. Participants: One hundred twenty-nine eyes from 72 glaucoma patients. Methods: All patients had been followed up for 2.9 to 6.1 years with a median follow-up of 4 months. All eyes had at least 4 serial RNFL measurements obtained with both the fast and the regular RNFL scans. Visual field (VF) assessment was performed on the same day as RNFL imaging. Retinal nerve fiber layer thickness and VF progression were evaluated with linear regression analysis against age. The mean rate of average RNFL thickness reduction was estimated with linear mixed modeling. Main Outcome Measures: The agreement of progression detection and the rate of change of RNFL thicknesses. Results: A total of 1373 fast and 1373 regular RNFL scans and 1236 VF tests were analyzed. With reference to the average RNFL thickness, the fast RNFL scan detected more eyes with progression (21 eyes from 19 patients vs. 15 eyes from 13 patients) than the regular scan at a comparable level of specificity (96.9% vs. 96.1%). More eyes were found to have increasing RNFL thickness with age at individual clock hours (except for 3, 5, 6, and 11 o'clock) when the measurements were obtained with the regular scan. The agreement between the fast and the regular scan for detection of RNFL progression was fair to moderate, with kappa values ranging between 0.14 and 0.49. The rate of average RNFL thickness progression was -1.01 mu m per year for the fast RNFL scan and -0.77 mu m per year for the regular scan. Conclusions: The choice of scan protocols in the Stratus OCT has a significant impact in the evaluation of RNFL progression. The fast RNFL scan seems to be preferable to follow RNFL damage in glaucoma. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. Ophthalmology 2011;118:763-767 (C) 2011 by the American Academy of Ophthalmology.