Study Highlights Retinal Thickness Changes Linked to Glaucoma Severity

Structural changes in the retina and optic nerve head, visualized using OCT, typically precede functional loss in glaucoma. Thinning of the circumpapillary retinal nerve fiber layer (cpRNFL), for example, is an early indicator of glaucomatous damage, and macular ganglion cell-inner plexiform layer (mGCIPL) thickness is another likely candidate for tracking progression. Uncovering the rates of thinning for these key retinal layers could improve disease monitoring and inform treatment decisions, according to Johns Hopkins and the University of Maryland researchers, who recently published their comparison of cpRNFL and mGCIPL for visual field progression in Ophthalmology. Both cpRNFL and mGCIPL are linked with progression in mild glaucoma. Experts say that changes in either measure at this stage could indicate progression, but individual patient factors such as thinner baseline thickness in one measure or concomitant disease affecting these measures like papilledema must be taken under consideration when interpreting the data. Photo: Andrew Rixon, OD. Click image to enlarge. The retrospective study included data from 2,464 eyes of 1,605 patients. Statistical analyses showed that cpRNFL and mGCIPL thinning rates were much faster in eyes with visual field progression (-1.02 and -1.04 µm/year, respectively) than those without (-0.41 and -0.41 µm/year, respectively). The researchers also observed that as disease severity worsened, the differences between progressors and non-progressors decreased.When assessing the effects of cpRNFL and mGCIPL thinning, analyses showed a similar impact on the likelihood of progression (2.4% vs. 2.1% increased chance per 1 µm/year faster rate of thinning), but this effect differed by the stage of disease: cpRNFL thinning’s effect was greatest in glaucoma suspects but wasn’t significant in advanced glaucoma. On the other hand, mGCIPL thinning’s effect was smallest in glaucoma suspects and increased with disease severity, with significant effects in advanced disease.“Our findings highlight complementary roles of cpRNFL and mGCIPL metrics in understanding glaucoma progression,” the authors concluded in their paper. Based on their findings, they recommend that clinicians consider “disease-stage-specific approaches to monitoring progression with these structural measures.”Click here for the journal source. Pham AT, Bradley C, Yohannan J. Comparing the utility of retinal nerve fiber layer and ganglion cell inner plexiform layer OCT changes to detect glaucoma progression. Ophthalmology 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.