Circumpapillary RNFL Changes Anticipate Disease Progression in Glaucoma

Guided progression analysis (GPA) is a software tool used on some OCT devices that can be used to predict the progression of glaucoma in suspect patients and primary open-angle glaucoma (POAG) patients. This program assesses different layers of the retina to make its prognosis. In order to further understand which elements of an OCT scan are prognostic for disease progression, a team of researchers from UCLA, UAB and Columbia conducted a study analyzing OCT GPA data from a cohort of glaucoma patients. Within a three-year period, glaucoma progression can be predicted within the first four examinations using OCT guided progression analysis. However, a longer period of time may concur with a later assessment of disease progression. Photo: Danica J. Marrelli, OD. Click image to enlarge. In their analysis, the researchers were determined to find whether the rate of circumpapillary retinal nerve fiber layer (cpRNFL) change over time correlated with the progression of glaucoma. Subjects were selected if they were glaucoma suspects or diagnosed with POAG and if they had a minimum of seven OCT scans on record. To find indications of glaucoma progression, GPA observational periods were scheduled at three and five years after each patient’s first initial exam, and initial cpRNFL slope was assessed for patients at exams two (scenario 1), three (scenario 2), four (scenario 3) and five (scenario 4) before these observational periods.“Our findings indicate that the first four OCT examinations are most predictive of GPA progression within a three-year timeframe,” said the authors in their paper. “In contrast, the initial five visits showed the highest predictive value over a five-year period. This suggests that future glaucoma progression could be estimated within approximately half of the initial observation period.”This study collected data from 307 patients with 472 glaucomatous eyes (132 suspects and 340 POAG eyes). Eyes categorized as early-stage glaucoma accounted for 253 of the 472 eyes in the cohort. The remaining glaucomatous eyes were either moderate (50 eyes) or advanced (37 eyes) at baseline. At the first GPA observational period (three years), 9.7% progressed at scenario 1, 16.9% progressed at scenario 2, 25.6% progressed at scenario 3 and 33.8% progressed at scenario 4. Conversely, as the researchers pointed out, at the second GPA observational period (five years), 39.2% progressed at scenario 1, 42.4% progressed at scenario 2, 42.2% progressed at scenario 3 and 40.4% progressed at scenario 4.Hazard ratios (HR) were calculated to determine the optimal scenario for predicting glaucoma progression as the rate of cpRNFL change increased over time. After adjusting the model, scenario 3 at three years was the most optimal scenario, with an HR of 1.76 per initial 1 μm/faster, and scenario 4 at five years was the most optimal scenario, with an HR of 1.65 per initial 1 μm/faster.“These findings support the potential use of OCT cpRNFL rates of change to assess the risk of glaucomatous progression,” concluded the authors. “While acknowledging the limitations of our patient sample and evaluation frequency, these findings underscore the potential of OCT in providing a more objective and reliable approach to monitoring glaucoma progression in clinical practice.” Click here for the journal source. Pham VQ, Nishida T, Moghimi S, et al. Initial circumpapillary retinal nerve fibre layer rates of change predict glaucomatous progression. Eye. September 22, 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.