Structure and Function in Glaucoma

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Structure and Function In Glaucoma

Paul H Artes, PhDOphthalmology and Visual Sciences,

Dalhousie University, Halifax, Canada

What do we know,

and how can we apply it?

EUPO Course 2011

European Glaucoma Society / EUPO

Geneva, June 3, 2011CR:Researchsupport,HeidelbergEngineering


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200 m200 m

ILMILM

RNFLRNFL

OCT ART (16) Q: 22 [HR]

TMP TMPSUP NAS INF

Thickness[m]

300

240

180

120

60

0

Position []

36031527022518013590450


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40 60 80 100 120

-20

-15

-10

-5

0

Retinal Nerve Fibre Layer Thickness, um

MeanDeviation,

dB

controlsglaucoma


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Normal range RNFLtNormal range VF


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Normal range RNFLtNormal range VF

Test Variability


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Structure & Function: Diagnosis Imaging tests have large normal ranges, but

excellent precision. More powerful for measuring change over time inserial exams than for interpreting a single exam.


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Structure/Function: Prediction

40 60 80 100 120

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0


MeanDeviation,d

B


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Structure/Function: Prediction

40 60 80 100 120

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MeanDeviation,d

B


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Structure & Function: Prediction Relationship is curvedas predicted from theory large scatter makes it difficult to predict function

from structure, or structure from function. Imaging cannot replace visual field assessment,

or vice versa.


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Structure & Function: Progression

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MeanDeviation,

dB

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MeanDeviation,dB

?


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Structure & Function: Progressionleast stringent criteria

VF change35

HRT change3520

VF change

HRT change

all 84 eyes

3

most stringent criteriaall

84 eyes15

14

Artes & Chauhan, Prog Ret Eye Res 2005


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Do not expect agreement between structure andfunction, either in diagnosis or progression. Imagingand visual fields are complementary they do notreplace each other.

Structure and function are equally important in allstages, but either S or F can be most useful inindividual patients.

Perform only those tests that can change yourmanagement, and be wary of average rules thatmay not apply to individual patients


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Thank you!


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Do not expect agreement between structureand function, either in diagnosis or progression. S and F equally important in all stages,

either S or F most useful in individuals. Perform only those tests that can change your

management. Be wary about applying general rules of thumb

to individual patients


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Take-Home Messages Use structure and function, (almost) always. Look at the data, carefully Weigh up the evidence Take structural changes seriously.

Structure and Function in Glaucoma

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