Impact of Atypical Retardation Patterns on Detection of Glaucoma Progression using the GDx with Variable Corneal Compensation

Medeiros, Felipe A.; Alencar, Luciana M.; Zangwill, Linda M.; Sample, Pamela A.; Susanna, Remo; Weinreb, Robert N.

doi:10.1016/j.ajo.2009.01.021

« Previous Next »American Journal of Ophthalmology
Volume 148, Issue 1 , Pages 155-163.e1, July 2009

Impact of Atypical Retardation Patterns on Detection of Glaucoma Progression using the GDx with Variable Corneal Compensation

Felipe A. Medeiros
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
- Inquiries to Felipe A. Medeiros, Hamilton Glaucoma Center, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093
Luciana M. Alencar
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
- Department of Ophthalmology, University of São Paulo, São Paulo, Brazil
Linda M. Zangwill
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
Pamela A. Sample
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California
Remo Susanna Jr
- Department of Ophthalmology, University of São Paulo, São Paulo, Brazil
Robert N. Weinreb
- Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, California

Accepted 27 January 2009. published online 17 April 2009.

Purpose

To evaluate the impact of atypical retardation patterns (ARP) on detection of progressive retinal nerve fiber layer (RNFL) loss using scanning laser polarimetry with variable corneal compensation (VCC).

Design

Observational cohort study.

Methods

The study included 377 eyes of 221 patients with a median follow-up of 4.0 years. Images were obtained annually with the GDx VCC (Carl Zeiss Meditec Inc, Dublin, California, USA), along with optic disc stereophotographs and standard automated perimetry (SAP) visual fields. Progression was determined by the Guided Progression Analysis software for SAP and by masked assessment of stereophotographs by expert graders. The typical scan score (TSS) was used to quantify the presence of ARPs on GDx VCC images. Random coefficients models were used to evaluate the relationship between ARP and RNFL thickness measurements over time.

Results

Thirty-eight eyes (10%) showed progression over time on visual fields, stereophotographs, or both. Changes in TSS scores from baseline were significantly associated with changes in RNFL thickness measurements in both progressing and nonprogressing eyes. Each 1-unit increase in TSS score was associated with a 0.19-μm decrease in RNFL thickness measurement (P < .001) over time.

Conclusions

ARPs had a significant effect on detection of progressive RNFL loss with the GDx VCC. Eyes with large amounts of atypical patterns, great fluctuations on these patterns over time, or both may show changes in measurements that can appear falsely as glaucomatous progression or can mask true changes in the RNFL.