GLAUCOMA IS A MULTIFACTORIAL OPTIC NEUROPathy characterized by progressi e !e"rodege!eratio! o# reti!a$ ga!g$io! ce$$s a!d their a%o!s& characterized by reti!

a$ !er e #iber $ayer 'RNFL( atte!"atio!& a speci#ic patter! o# da)age to the optic !er e head& a!d is"a$ #ie$d $oss*+&, A$tho"gh both str"ct"ra$ a!d #"!ctio!a$ da)age occ"r i! g$a"co)a& co!tro ersy e%ists regardi!g -hether s"bsta!tia$ RNFL atte!"atio! precedes #"!ctio!a$ $oss )eas"red by sta!dard a"to)ated peri)etry* GLAU.OMA ada$ah opti/ !e"ropati ya!g )"$ti#a/tora$ dita!dai de!ga! !e"rodege!erasi progresi# dari se$0se$ ga!g$io! da! a/so! reti!a& di)a!a ter1adi!ya /e$e)aha! pada $apisa! serat sara# reti!a 'RNFL(& )er"pa/a! po$a spesi#i/ dari /er"sa/a! optic !er e da! $apa!g pa!da!g* Mes/ip"! pada g$a"co)a ter1adi /er"sa/a! str"/t"ra$ da! #"!gsio!a$& terdapat /o!tro ersi )e!ge!ai apa/ah /e$e)aha! s"bsta!sia$ RNFL )e!dah"$"i /er"sa/a! #"!gsio!a$ /er"gia! ya!g di"/"r de!ga! sta!dar peri)etry oto)atis* The re$atio!ship bet-ee! sig!a$0to0!oise ratio&,2 stage o# g$a"co)ato"s da)age&,+ a!d the tech!i3"e a!d regio! o# is"a$ #ie$d st"died ha e sig!i#ica!t i)pacts o! the co)pariso! o# str"ct"re a!d #"!ctio! #or the progressio! o# g$a"co)a*4&,,&,4 5"b"!ga! a!tara sig!a$0to0!oise rasio& stagi!g /er"sa/a! g$a"co)a& te/!i/ da! $"as $apa!g pa!da!g )e)i$i/i da)pa/ ya!g sig!i#i/a! pada perba!di!ga! str"/t"r da! #"!gsi da$a) per/e)ba!ga! g$a"/o)a Novel imaging technologies have been developed that are capable of quantifying early glaucomatous damage at the micron level using structural measures Teknologi pencitraan baru telah dikembangkan yang mampu mengidentifikasi kerusakan pada glaucoma hingga tingkat micron. Ti)e0do)ai! 'T6( optica$ cohere!ce to)ography '7OCT89 Strat"s OCT9 Car$ :eiss Meditec& 6"b$i!& Ca$i#or!ia& USA( is

a high0reso$"tio!& )icro!0sca$e& cross0sectio!a$ i)agi!g )ethod that pro ides 3"a!titati e assess)e!ts o# the reti!a a!d optic !er e head a!d is capab$e o# discri)i!ati!g bet-ee! !or)a$ a!d g$a"co)ato"s eyes a!d detecti!g $o!git"di!a$ $oss o# RNFL thic/!ess i! g$a"co)a*+ Ti)e0do)ai! 'T6( optica$ cohere!ce to)ography '7OCT89 Strat"s OCT9 Car$ :eiss Meditec& 6"b$i!& Ca$i#or!ia& USA( ada$ah )esi! de!ga! reso$"si ti!ggi& s/a$a )icro! ya!g )e)beri/a! pe!i$aia! /"a!titati# pada reti!a da! sara# opti/ serta )a)p" )e)beda/a! a!tara )ata !or)a$ da! g$a"/o)a da! )e!dete/si hi$a!g!ya /eteba$a! RNFL pada g$a"co)a* The is"a$ #ie$d i!de% ';FI( is a ca$c"$ated i!de% a$$ocated to each is"a$ #ie$d that deter)i!es the $e e$ o# ab!or)a$ity o# the #ie$d* The ;FI "ses the patter! de iatio! 'P6( probabi$ity )ap to ide!ti#y the test $ocatio!s that are co!sidered either !or)a$ a!d scored as +22< or abso$"te de#ect a!d scored as 2<* =ida!g is"a$ i!de/s ';FI( ada$ah seb"ah i!de/s ya!g dihit"!g da! dia$o/asi/a! "!t"/ )asi!g0 )asi!g bida!g is"a$ ya!g )e!e!t"/a! ti!g/at /e$ai!a! $apa!ga! pa!da!g* ;FI )e!gg"!a/a! )etode probabi$itas po$a de iasi 'P6( "!t"/ )e!gide!ti#i/asi bagia!0bagia! ya!g dia!ggap !or)a$ dan scored as 100% or absolute defect and scored as 0%. The re)ai!i!g test $ocatio!s -ith re$ati e $oss o! the P6 p$ot are scored i! as a perce!tage based o! their tota$ de iatio! a$"e a!d age0corrected !or)a$ thresho$d*42 =eca"se ;FI "ses P6 probabi$ity )aps& it is $ess a##ected by cataract* A -eighti!g proced"re is app$ied to each test $ocatio! "si!g a! esti)ate o# the spatia$ )ag!i#icatio! prese!t i! the occipita$ corte% that di ides the test patter! i!to > co!ce!tric ri!gs o# i!creasi!g ecce!tricity*

The ? test ce!tra$ $ocatio!s& !ot i!c$"di!g )eas"re)e!t o# #o ea$ thresho$d& are a$$otted the highest -eight& a!d the -eights decrease -ith i!creasi!g ecce!tricity* The ;FI is the )ea! o# a$$ -eighted scores i! perce!t* The ;FI scori!g syste) )as/s ear$y g$a"co)ato"s da)age by assig!i!g a per#ect score to the test $ocatio!s that are co!sidered !or)a$ o! the P6 p$ot& b"t )ay ha e decreased tota$ de iatio! a$"es* The p"rpose o# this st"dy -as to co)pare prospecti e$y the detectio! o# progressi e RNFL $oss ide!ti#ied "si!g T6 OCT -ith is"a$ #ie$d progressio! )eas"red "si!g sta!dard a"to)ated peri)etry i! g$a"co)a s"spect a!d preperi)etric g$a"co)a patie!ts a!d i! peri)etric g$a"co)a patie!ts* 4 tempat yang di nilai, kecuali pengukuran foveal ambang batas yang dialokasikan tertinggi berat, dan bobot penurunan dengan meningkatnya eksentrisitas. Lkp yang semua adalah rata-rata tertimbang nilai dalam persen. Lkp yang mencetak gol awal sistem masker glaucomatous kerusakan oleh menetapkan sebuah sempurna skor untuk menguji lokasi yang dianggap normal pada pd plot, tapi mungkin telah menurun total nilai. penyimpangan Tujuan dari penelitian ini adalah untuk membandingkan prospectively deteksi rnfl progresif kerugian diidentifikasi menggunakan visual td lapangan oktober dengan perkembangan diukur menggunakan standar perimetry otomatis di glaukoma tersangka dan preperimetric glaukoma pasien dan di perimetric glaukoma pasien.

MET5O6 STU6@ POPULATIONA This -as a prospecti e& !o!ra!do)ized& $o!git"di!a$ c$i!ica$ tria$* Participa!ts co!sisted o# g$a"co)a s"spect a!d preperi)etric g$a"co)a patie!ts a!d peri)etric g$a"co)a patie!ts -ith ,B )o!ths or )ore o# #o$$o-0"p -ho -ere e!ro$$ed i! Ad a!ced I)agi!g #or G$a"co)a St"dy co!d"cted at the =asco) Pa$)er& Casey& a!d 6ohe!y Eye I!stit"tes a!d the U!i ersity o# Pittsb"rgh Medica$ Ce!ter Eye Ce!ter* I!c$"sio! criteria co))o! to both gro"ps co!sisted o# spherica$ e3"i a$e!t re#racti e error bet-ee! CD*22 a!d 4*22 diopters '6( sphere& best0corrected is"a$ ac"ity o# ,2E?2 or better& age bet-ee! ?2 a!d B2 years& a!d !o prior history o# i!traoc"$ar s"rgery e%cept #or "!co)p$icated cataract e%tractio!* S"b1ects -ith oc"$ar disease other tha! g$a"co)a or cataract& parapapi$$ary atrophy e%te!di!g to +*D )) #ro) the ce!ter o# the optic disc& "!re$iab$e is"a$ #ie$d& or poor03"a$ity optic !er e head or RNFL i)ages -ere e%c$"ded* The g$a"co)a s"spect a!d preperi)etric g$a"co)a eyes co!sisted o# eyes -ith oc"$ar hyperte!sio! characterized by i!traoc"$ar press"re o# ,? )) 5g or )ore -ith !or)a$ optic discs a!d !or)a$ sta!dard a"to)ated peri)etry de#i!ed as g$a"co)a he)i#ie$d test res"$ts -ithi! !or)a$ $i)its a!d )ea! de iatio! 'M6( a!d patter! sta!dard de iatio! 'PS6( -ithi! F>< co!#ide!ce i!ter a$ $i)its& or patie!ts -ith g$a"co)ato"s optic !e"ropathy o! #"!d"scopic e%a)i!atio! a!d re ie- o# stereoscopic optic disc photographs& b"t !or)a$ is"a$ #ie$d* G$a"co)ato"s optic !e"ropathy -as de#i!ed as !e"roreti!a$ ri) !arro-i!g to the optic disc )argi!& !otchi!g& e%ca atio!& or RNFL de#ect* The peri)etric g$a"co)a patie!ts had g$a"co)ato"s

optic !er e da)age a!d correspo!di!g ab!or)a$ is"a$ #ie$d de#i!ed as ab!or)a$ g$a"co)a he)i#ie$d test res"$ts a!d PS6 o"tside !or)a$ F>< co!#ide!ce i!ter a$ $i)its* Patie!ts -ith is"a$ #ie$d ab!or)a$ities had at $east + co!#ir)atory is"a$ #ie$d e%a)i!atio!* A$$ patie!ts "!der-e!t a base$i!e e%a)i!atio! co!sisti!g o# a co)p$ete ophtha$)ic e%a)i!atio! i!c$"di!g s$it0$a)p bio)icroscopy& go!ioscopy& Go$d)a!! app$a!atio! to!o)etry& "$traso"!d pachy)etry& di$ated stereoscopic e%a)i!atio! a!d photography o# the optic disc& sta!dard a"to)ated peri)etry& a!d RNFL i)agi!g* The RNFL i)agi!g -as per#or)ed "si!g T6 OCT ' ersio! >*2*+& Strat"s OCT9 Car$ :eiss Meditec( e ery G )o!ths* 6"ri!g the #o$$o-0"p period& each patie!t -as treated at the discretio! o# the atte!di!g physicia!* C TIME06OMAIN OPTICAL CO5ERENCE TOMOGRAP5@A The T6 OCT -as "sed to )eas"re the RNFL thic/!ess* The so#t-are deter)i!es the RNFL thic/!ess as the dista!ce bet-ee! the itreoreti!a$ interface a!d a posterior border based o! a prede#i!ed re#$ecti ity sig!a$ $e e$* The ca$ibratio! -as chec/ed a!!"a$$y i! accorda!ce -ith the )a!"#act"rerHs g"ide$i!es by a"thorized tech!icia!s* At each isit& t-o i)ages -ere ac3"ired #ro) each s"b1ect* Each i)age co!sisted o# 4 sets o# ,>G A0sca!s a$o!g a 4*?0)) dia)eter circ")papi$$ary sca! ce!tered at the optic !er e head* TIME06OMAIN OPTICAL CO5ERENCE TOMOGRAP5@A The T6 OCT digunakan untuk mengukur ketebalan R !L. "erangkat lunak yang menentukan ketebalan R !L sebagai jarak antara vitreoretinal dan batas posterior berdasarkan tingkat sinyal reflektivitas standar. #alibrasi diperiksa setiap tahunnya

sesuai dengan produsen $ u%&'(s panduan oleh teknisi yang berwenang. "ada setiap kunjungan, dua gambar yang )iperoleh dari setiap mata pelajaran. *asing-masing gambar terdiri dari + set ,-scan %-. sepanjang scan circumpapillary +.4-mm diameter yang berpusat di kepala saraf optik. The #ast0sca!!i!g )ode -as "sed& i! -hich a$$ sca!s are ac3"ired a!d a$ig!ed a"to)atica$$y a#ter i!itia$ positio!i!g a!d ac3"isitio! by the operator* The repeat sca! optio! i!corporated i! T6 OCT -as "sed to opti)ize the a$ig!)e!t o# the #o$$o-0"p sca! circ$e a!d the base$i!e i)age* Peripapi$$ary RNFL thic/!ess para)eters e a$"ated i! this st"dy -ere a erage thic/!ess '4G2 degrees(& s"perior 3"adra!t thic/!ess '?G to +4> degrees(& a!d i!#erior 3"adra!t thic/!ess ',,G to 4+> degrees(* *odus pemindaian cepat digunakan, di mana semua scan diperoleh dan selaras secara otomatis setelah posisi awal dan akuisisi oleh operator. /langi scan opsi yang tergabung dalam T) 01T digunakan untuk mengoptimalkan keselarasan tata lingkaran scan tindak lanjut dan gambar dasar. "eripapillary R !L ketebalan parameter dievaluasi dalam studi ini adalah rata-rata ketebalan 2+.& derajat3, unggul kuadran ketebalan 24.-'+- derajat3 dan inferior kuadran ketebalan 2%%. untuk +'- derajat3. These a$"es -ere pro ided i! the pri!to"t a#ter a eragi!g the res"$ts o# 4 se3"e!tia$ circ"$ar sca!s capt"red d"ri!g ac3"isitio!* Poor03"a$ity sca!s -ere e%c$"ded& i!c$"di!g i)ages that -ere "!#oc"sed& poor$y ce!tered& obtai!ed d"ri!g eye )o e)e!t& or had a sca! score $ess tha! G& or those -ith #ai$"re to seg)e!t the borders o# the RNFL correct$y* C 6EFINITION OF PROGRESSIONA Sta!dard a"to)ated peri)etry -as per#or)ed "si!g the S-edish i!teracti e thresho$d a$gorith) '5")phrey Fie$d A!a$yzer D>2 II0i& ,?0, SITA Sta!dard9 Car$ :eiss Meditec(* Re$iab$e test

res"$ts& de#i!ed as 44< or $ess #i%atio! $osses& #a$se!egati e rates& a!d #a$se0positi e rates& -ere i!c$"ded* A$$ patie!ts -ere e%perie!ced -ith a"to)ated peri)etry a!d had "!dergo!e a )i!i)") o# , is"a$ #ie$d tests be#ore st"dy e!ro$$)e!t* =oth eyes o# e$igib$e patie!ts e!ro$$ed i! the Ad a!ced I)agi!g #or G$a"co)a St"dy -ith ,B )o!ths or )ore o# #o$$o-0"p a!d re$iab$e is"a$ #ie$d -ere i!c$"ded* T6 OCT a!d sta!dard a"to)ated peri)etry -ere )eas"red e ery G )o!ths* Progressio! -as de#i!ed as a sig!i#ica!t 'P I *2>( !egati e s$ope i! the a!!"a$ rate o# cha!ge i! ;FI a!d RNFL* The occ"rre!ce o# is"a$ #ie$d progressio! -as de#i!ed as the #irst #o$$o-0"p isit reachi!g a sig!i#ica!t 'PI*2>( !egati e ;FI s$ope o er ti)e* I)pro e)e!t -as de#i!ed as a sig!i#ica!t 'P I *2>( positi e s$ope i! the a!!"a$ rate o# cha!ge i! ;FI a!d RNFL* Speci#icity -as de#i!ed as the !")ber o# eyes -ith !either progressio! !or i)pro e)e!t& di ided by the !")ber o# eyes -itho"t progressio!* C STATISTICAL ANAL@SISA Statistica$ a!a$ysis -as per#or)ed "si!g SAS so#t-are ersio! F*, 'SAS I!c& Cary& North Caro$i!a& USA( to detect progressi e RNFL $oss a!d is"a$ #ie$d progressio! i! g$a"co)a s"spect a!d preperi)etric g$a"co)a patie!ts a!d i! peri)etric g$a"co)a patie!ts* A$$ tests -ere ,0sided& a!d a P a$"e o# $ess tha! *2> -as co!sidered sig!i#ica!t* The a erage o# , high3"a$ity )eas"re)e!ts that )et the i!c$"sio! criteria -as "sed #or the statistica$ a!a$ysis* A! a!a$ysis o# aria!ce -as "sed to co)pare the co!ti!"o"s ariab$es& a!d the chi0s3"are test -as "sed #or the categorica$ ariab$es* Jhe! app$icab$e& the ge!era$ esti)ati!g e3"atio! )ethod

-as "sed to ad1"st #or corre$atio! bet-ee! the , eyes o# the sa)e patie!t*4, U!i ariate a!d )"$ti ariate Co% proportio!a$ hazard ratios '5Rs( -ith F>< co!#ide!ce i!ter a$s -ere ca$c"$ated "si!g "!i ariate a!d )"$ti ariate )ode$s -ith RNFL $oss as a ti)e0depe!de!t co ariate to ide!ti#y the ris/ #actors predicti e o# is"a$ #ie$d progressio!* U!i ariate Co% proportio!a$ hazard regressio! )ode$s e%a)i!ed the 5Rs #or the i!di id"a$ para)eters a!d -ere !ot ad1"sted #or the prese!ce o# other #actors* Predictors -ith a P a$"e o# 2*+ or $ess -ere e a$"ated #or the )"$ti ariate )ode$s thro"gh step-ise se$ectio!* Separate )ode$s -ere co!str"cted #or )"$ti ariate a!a$yses* Each )ode$ i!c$"ded + i)agi!g para)eter a!d age a!d is"a$ #ie$d PS6 at base$i!e* For Co% )ode$s& a tech!i3"e ca$$ed rob"st sa!d-ich co aria!ce esti)ate -as "sed i! the Ja$d tests to ad1"st #or corre$atio! bet-ee! , eyes #ro) the sa)e patie!t*44 Three types o# .ap$a!0Meier c"r es -ere created to co)pare the s"r i a$ ti)es #or peri)etric g$a"co)a eyes ers"s g$a"co)a s"spect a!d preperi)etric g$a"co)a eyes 'Fig"re +(& the eyes that had sig!i#ica!t $oss o# RNFL ers"s those that did !ot 'Fig"re ,(& a!d RNFL $oss ers"s ;FI $oss 'e%p$ai!ed i! the Res"$ts(*