Rapid initial OCT RNFL thinning is predictive of faster visual field loss during extended follow-up in glaucoma.

Journal Article (Journal Article)


To investigate the relationship between the rate of retinal nerve fiber layer (RNFL) loss during initial follow-up and the magnitude of associated visual field loss during an extended follow-up period.


Retrospective cohort study.


A total of 1,150 eyes of 839 glaucoma patients extracted from the Duke Glaucoma Registry. Rates of RNFL loss were obtained from global RNFL thickness values of the first 5 optical coherence tomography (OCT) scans. Rates of visual field loss were assessed using standard automated perimetry mean deviation (SAP MD) during the entire follow-up period. Joint longitudinal mixed effects models were used to estimate rates of change. Eyes were categorized as fast, moderate or slow progressors based on rates of RNFL loss, with cutoffs of ≤-2 µm/year, -2 to -1 µm/year and ≥-1 µm/year, respectively. Univariable and multivariable regressions were completed to identify significant predictors of SAP MD loss.


The rate of RNFL change was -0.76±0.85 µm/y during initial follow-up, which occurred over 3.7±1.5 years. 765 (66%) eyes were slow, 328 (29%) moderate, and 57 (5%) fast progressors, with rates of RNFL thinning of -0.36±0.54 µm/year, -1.34±0.25 µm/year, and -2.87±1.39 µm/year respectively. The rates of SAP MD loss among slow, moderate, and fast OCT progressors were -0.16±0.35 dB/y, -0.32±0.43 dB/y, and -0.71±0.65 dB/y respectively over the extended follow-up period of 6.1±1.9 years (P<0.001). Age, OCT progressor group, and concurrent SAP rate were all significantly associated with the overall rate of SAP MD loss in a multivariable model (all P<0.001).


Rapid RNFL thinning during an initial follow-up period was predictive of concurrent and subsequent rates of visual field decline over an extended period.

Full Text

Duke Authors

Cited Authors

  • Swaminathan, SS; Jammal, AA; Berchuck, SI; Medeiros, FA

Published Date

  • September 2021

Published In

Volume / Issue

  • 229 /

Start / End Page

  • 100 - 107

PubMed ID

  • 33775658

Pubmed Central ID

  • PMC8759244

Electronic International Standard Serial Number (EISSN)

  • 1879-1891

International Standard Serial Number (ISSN)

  • 0002-9394

Digital Object Identifier (DOI)

  • 10.1016/j.ajo.2021.03.019


  • eng