Xinbo Zhang, Nils Loewen, Ou Tan, David S. Greenfield, Joel S. Schuman, Rohit Varma, David Huang, Advanced Imaging for Glaucoma Study Group, David Huang, Brian Francis, David S. Greenfield, Richard K. Parrish, Joel S. Schuman, Rohit Varma, Krishna S. Kishor, Carolyn D. Quinn, Shawn Iverson, Nayara Kish, Jose Rebimbas, Debra Weiss, Vikas Chopra, John Gil-Flamer, Judith Linton, Sylvia Ramos, Eiyass Albeiruti, Nils Loewen, Robert Noecker, Michael DeRosa, Greg Owens, Melessa Salay, Kristy Truman, Janice Ladwig, Michelle Montalto, Hiroshi Ishikawa, Larry Kagemann, Mitra Sehi, Ou Tan, Yimin Wang, Gadi Wollstein, Sharon Bi, Swati Chakraborty, Robert DiLaura, Bo Hu, John Sell, Eleonore Savatovsky, Srinivas R. Sadda, Ranjith Konduru, Elnaz Rakhshan, Sowmya Srinivas, Ake T.H. Lu, Xinbo Zhang

To predict the development of glaucomatous visual field (VF) defects using Fourier-domain optical coherence tomography (FD-OCT) measurements at baseline visit. Multi-center longitudinal observational study. Glaucoma suspects and pre-perimetric glaucoma participants in the Advanced Imaging for Glaucoma Study. The optic disc, the peripapillary retinal nerve fiber layer (NFL), and macular ganglion cell complex (GCC) were imaged with FD-OCT VF was assessed every 6 months. Conversion to perimetric glaucoma was defined by VF pattern standard deviation (PSD) or glaucoma hemifield test (GHT) outside normal limits on 3 consecutive tests. Hazard ratios were calculated with the Cox proportional hazard model. Predictive accuracy was measured by the area under the receiver-operating-characteristic curve (AUC). Of 513 eyes (309 participants), 55 eyes (46 participants) experienced VF conversion during 41 ± 23 months of follow-up. Significant (p<0.05, Cox regression) FD-OCT risk factors included all GCC, NFL, and disc variables, except for horizontal cup-to-disc ratio. GCC focal loss volume (FLV) was the best single predictor of conversion (AUC=0.753, p<0.001 for test against AUC = 0.5). Those with borderline or abnormal GCC-FLV had a 4-fold increase in conversion risk after 6 years (Kaplan-Meier). Optimal prediction of conversion was obtained using the glaucoma composite conversion index (GCCI) based on a multivariate Cox regression model that included GCC-FLV, inferior NFL quadrant thickness, age, and VF PSD. GCCI significantly improved predictive accuracy (AUC=0.783) over any single variable (p=0.04). Reductions in NFL and GCC thickness can predict the development of glaucomatous VF loss in glaucoma suspects and pre-perimetric glaucoma patients.