Assessment of structural glaucoma progression

Abstract

Purpose: To provide an update on the role of optic nerve head and peripapillary retinal nerve fiber layer imaging in monitoring glaucoma progression. Methods: Review of literature. Results: Imaging technologies, such as optical coherence tomography, scanning laser polarimetry, and confocal scanning laser ophthalmoscopy, objectively and quantitatively measure the structural change associated with glaucoma. Rates of retinal nerve fiber layer (RNFL) and rim area loss are significantly faster in progressing compared with nonprogressing subjects. A number of strategies to detect progression have been proposed. The precision of these methods is generally high. However, there is no agreement as to which instrument or parameter is most appropriate for the evaluation of structural progression associated with glaucoma at this moment. The agreement between structural and functional glaucoma progression is generally poor regardless of the strategies used. Structural progression analyses appear to complement visual field progression analyses, detecting a different subset of progressing subjects. Summary: Imaging devices are promising tools for monitoring patients with glaucoma. Combining structural and functional analyses is useful for accurate monitoring of glaucoma progression.