Glaucoma - Detection

How can OCT help us detect glaucomatous damage?

This work was originally proposed as part of a RO1 grant submitted about 8 years ago; the proposal received a perfect score (10) from the Study Section, who thought the work would “change the focus” of glaucoma research. This work is, in fact, slowly changing the clinical focus from damage largely outside the central retina to the damage in the center of the all-important macular region. We proposed a novel anatomical model to explain why the most common clinical test for glaucoma (the 24-2 visual field) underestimates macular damage. It can also be missed by the most common OCT analysis, as well (ref 3). In ref 4, we show that this damage can be widespread, as well as local. In ref 5, we show how points can be added to the 24-2 pattern so that macular damage is detected better. This suggestion has led to Zeiss designing a modified 24-2 for this purpose. Further, as part of this work, we (ref 6) proposed a novel way to compare visual fields and OCT data to help the clinician better detect glaucomatous damage, especially in the macula. This has been incorporated in our reports mentioned in A, which allow for accurate detection of macular damage (ref A2, and ref 7&8).

Relevant Recent Reviews/Papers:

  1. Hood DC, Raza AS, de Moraes CGV, Liebmann JM, Ritch R. (2013) Glaucomatous damage of the macula. Progress in Retinal and Eye Research. 32, 1-21
  2. Hood DC, Raza AS, de Moraes CGV, Odel JG, Greensten VC, Liebmann JM, Ritch R (2011) Initial arcuate defects within the central 10 degrees in glaucoma. Investigative Ophthalmology and Visual Science. 52, 940-946.
  3. Wang DL, Raza AS, de Moraes CG, Chen M, Alhadeff P, Jarukatsetphorn R, Ritch R,Hood DC. (2015) Central glaucomatous damage of the macula can be overlooked by conventional OCT retinal nerve fiber layer thickness analysies. Translational Visual Science & Technol 4(6):4
  4. Hood DC, Slobodnick A, Raza AS, De Moraes CG, Teng CC, Ritch R. (2014) Early glaucoma involves both deep local, and shallow widespread, retinal nerve fiber damage of the macular region. Investigative Ophthalmology and Visual Science. 55, 632-49.
  5. Ehrlich AC, AS Raza, R Ritch, DC Hood (2014) Modifying the conventional visual field test pattern to improve the detection of early glaucomatous defects in the central 10° Tran Vis Sci Tech. 3, No. 6.
  6. Hood, DC, Raza AS. (2011) Method for comparing visual field defects to local RNFL and RGC damage seen on frequency domain OCT in patients with glaucoma. Biomedical Optics Express. 2, 1097–1105.
  7. Hood DC, Raza AS (2014) On improving the use of OCT imaging for detecting glaucomatous damage. British Journal of Ophthalmology, 98, Suppl 2:ii1-9.
  8. Hood DC, Raza AS, De Moraes CG, Alhadeff PA, Idiga J, Blumberg DM, Liebmann JM, Ritch R. (2014) Evaluation of a one-page report to aid in detecting glaucomatous damage. Translational Vision Science & Technology 3, Dec 17;3(6):8.