- Design
- Retrospective cohort from a longitudinal glaucoma study
- Population
- 180 eyes of 116 patients with glaucoma or suspected glaucoma, mean 5.1 years follow-up
- Primary outcome
- Timing of event-based progression by OCT, OCTA and visual field
- Effect
- OCTA vessel density lead time 2.3 years before field progression (95% CI 1.3–3.2); specificity 68.9% vs 75.6% for OCT
From the Diagnostic Innovations in Glaucoma Study, 180 eyes of 116 patients had at least four OCT, OCT angiography and visual field tests over a mean five years. Progression was called when change exceeded test–retest variability on two consecutive visits.
Progression was detected in 59% of eyes by at least one test. OCT angiography vessel density detected it first in 37% of progressing eyes, OCT nerve fibre layer in 30% and fields in 24%. Vessel density signalled change a mean 2.3 years before the visual field (95% CI 1.3–3.2). Specificity in stable eyes was 69% for vessel density and 76% for OCT.
Earlier detection comes with more false alarms, and OCT angiography adds cost. It is a complementary tool for high-risk eyes rather than a replacement for fields.
- Consider OCT angiography as an extra monitoring tool in glaucoma patients at high risk of progression.
- Confirm suspected progression on repeat testing before changing treatment.
- Keep visual fields in the monitoring schedule; they measure what patients notice.
- Expect more false positives with vessel density than with OCT.
Why it matters
A two-year lead time could allow treatment to be stepped up before field loss.
Don't overread it
A retrospective single-programme cohort cannot show that earlier detection improves outcomes.
The statistics, in plain English
Specificity of 69% means about three in ten stable eyes were wrongly flagged as progressing by vessel density, which is why confirmation matters.
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