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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-15
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-5
0
Retinal Nerve Fibre Layer Thickness, um
MeanDeviation,d
B
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Structure/Function: Prediction
40 60 80 100 120
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-15
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-5
0
Retinal Nerve Fibre Layer Thickness, um
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
40 60 80 100 120
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-5
0
Retinal Nerve Fibre Layer Thickness, um
MeanDeviation,
dB
40 60 80 100 120
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-15
-10
-5
0
Retinal Nerve Fibre Layer Thickness, um
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.