Comparing Rates of Change in Moderate to Advanced Glaucoma: Retinal Nerve Fiber Layer Versus Bruch Membrane Opening-Minimum Rim Width

& BULL; PURPOSE: To compare rates of change (RoC) of peri-papillary retinal nerve fiber layer (RNFL) and Bruch membrane opening-based minimum rim width (BMO-MRW) thickness in moderate-to-advanced glaucoma.& BULL; DESIGN: Prospective cohort study.& BULL; METHODS: Longitudinal optical coherence tomography (OCT) optic nerve head volume scans of 113 eyes of 113 glaucoma patients with moderate-to-advanced or central damage were exported. This study estimated and com-pared global and sectoral RoC with linear mixed effects models and simple linear regression (SLR) of RNFL and BMO-MRW thickness. Permutation analyses were used to test significance of RoC in the SLR model. It also com-pared longitudinal signal-to-noise ratios (LSNR) defined as RoC divided by residual standard deviation (SD) be-tween the two groups.& BULL; RESULTS: Mean (SD) follow-up and median (IQR) OCT scan sessions were 5.2 (1.3) years and 10 (8-11), respectively. Baseline average (SD) visual field mean de-viation was-9.2 (5.8) dB. Based on SLR, a higher pro-portion of significant negative RNFL RoC was observed compared to BMO-MRW in the inferotemporal (35% vs 20%; P = .015) and inferonasal (42% vs 17%; P < .001) sectors. Permutation analyses also demonstrated a higher proportion of worsening RNFL RoC than BMO-MRW in the inferotemporal (P = .026) and inferonasal (P < .001) sectors along with overall lower positive RoC. Longitu-dinal signal-to-noise ratios for RNFL were significantly more negative than for BMO-MRW globally, and in the inferotemporal, inferonasal, and superonasal sectors (P < .01).& BULL; CONCLUSIONS: Longitudinal RNFL OCT measure-ments are more likely to detect structural change and demonstrate better LSNR compared with BMO-MRW in eyes with central or moderate-to-advanced glaucoma dam-age at baseline. (Am J Ophthalmol 2023;253: 181-188. & COPY; 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ ))

Automated summary

This study compared the rates of change in RNFL and BMO-MRW thickness in moderate-to-advanced glaucoma. It found that RNFL had a higher rate of change than BMO-MRW in the inferotemporal and inferonasal sectors, and RNFL also had better longitudinal signal-to-noise ratios.