PURPOSE: To compare longitudinal glaucoma progression detection using optical coherence tomography (OCT) and visual field (VF).

DESIGN: Validity assessment METHOD: We analyzed subjects with more than 5 follow-up visits (every 6 months) in the multi-center Advanced Imaging for Glaucoma Study. Fourier-domain optical coherence tomography (OCT) was used to map the thickness of the peripapillary retinal nerve fiber layer (NFL) and ganglion cell complex (GCC). OCT-based progression detection was defined as a significant negative trend for either NFL or GCC. VF progression was reached if either the event or trend analysis reached significance.

RESULT: The analysis included 417 glaucoma suspect/pre-perimetric glaucoma (GS/PPG) eyes and 377 perimetric glaucoma (PG) eyes. In the GS/PPG group, progression was detect in 38.9% of eyes by OCT, significantly more (P<0.001) than the detection rate of 18.7% by VF. In severity-stratified analysis of PG eyes, OCT had significantly higher detection rate in early PG (49.7% vs. 32.0%, p=0.02), but not significantly different in moderate and advanced PG. The rate of NFL thinning declined dramatically in advanced PG, but GCC thinning rate remained relatively steady and allowed good progression detection even in advanced disease. The rate of false positive progression detection in permutated series was over 10% for VF trend analysis in both GS/PPG and PG group, while under 7% for both GCC and NFL.

CONCLUSION: OCT is a more sensitive than VF for the detection of progression in early glaucoma. While the value of NFL declines in advanced glaucoma, GCC appears to be a useful progression detector from early to advanced stages.