Advanced Glaucoma Progression Study (AGPS)
|Primary Open Angle Glaucoma Pseudoexfoliative Glaucoma Chronic Angle Closure Glaucoma|
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||Detection of Glaucoma Progression Study With Macular OCT Imaging|
- Visual field progression [ Time Frame: 5 years ]Worsening of the MD and/or increased visual field loss within the central 10 degrees of the field.
- Worsening of OCT measurements [ Time Frame: 5 Years ]Worsening of macular and retinal nerve fiber layer (RNFL) OCT measurements.
- Contrast sensitivity [ Time Frame: 5 years ]Looking at any changes in contrast sensitivity using the Vector Vision CSV-1000 eye chart.
|Study Start Date:||May 2012|
|Estimated Study Completion Date:||August 2018|
|Estimated Primary Completion Date:||August 2018 (Final data collection date for primary outcome measure)|
Patients with MD < -6 or visual field loss within the central 10 degrees of the visual field.
Glaucoma is a major public health issue worldwide and manifests clinically as a chronic progressive optic neuropathy with concomitant visual field (VF) loss. Glaucoma can cause significant visual disability and decreased quality of life (1). Based on WHO's report in 2002, glaucoma is the second cause of blindness. The key to prevention of visual loss from glaucoma is early detection of the disease or its progression and timely treatment. Glaucoma can be quite advanced at the time of initial detection. The prevalence of advanced glaucoma at the time of diagnosis varies but can be quite high. For example, the average VF mean deviation (MD) in patients diagnosed with glaucoma in the Los Angeles Latino Eye Study was −9.6 dB (2), which represents moderately advanced to severe glaucoma. Detection of progression in advanced stages of glaucoma continues to be challenging. Visual field examination remains the gold standard for detection of progression in advanced glaucoma. However, long-term VF variability or noise in such eyes is significant, which could confound detection of change. The optic nerve head and peripapillary retinal nerve fiber layer (RNFL) demonstrate significant damage in such eyes and hence are not helpful for detection of change. About 50% of retinal ganglion cells (RGCs) are located within 4-5 mm of the macular center (3). Since the macular RGCs are the last ones to be affected in glaucoma, measurement of macular retinal thickness or retinal sublayers could provide significant information with regard to the course of advanced glaucoma.
The macular retinal sublayers can now be measured with reasonable accuracy with SD- OCTs. There is some evidence that measurement of the macular ganglion cell complex (GCC, combined thickness of RNFL, RGC and inner plexiform layer or IPL), or macular retinal thickness or volume may detect early glaucoma with a performance that approximates that of circumpapillary RNFL thickness measurements (4,5). In addition, such macular measurements have proved to be very reproducible (4,6). Given this excellent reproducibility, macular outcome measures would be the main candidates for following glaucoma eyes with advanced damage, in which the macular region is essentially the only retinal area with residual RGCs.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01742819
|United States, California|
|UCLA Jules Stein Eye Institute|
|Los Angeles, California, United States, 90095|
|Principal Investigator:||Kouros Nouri-Mahdavi, MD, MSc||Jules Stein Eye Institute, UCLA|