Tip of the Month
Publishing date: September 2023
Thanks to its high reproducibility (1-3), OCT has become widely used for monitoring structural optic nerve changes in glaucoma patients, complementary to the monitoring of optic nerve function with visual field analysis.
Recent evidence suggests that performing circumpapillary retinal fiber layer (RNFL) measurement with OCT at closer intervals, compared to yearly testing, considerably decreases the time needed to detect both moderate and rapid progression (4-6). While closer testing intervals (e.g. 4 months) are more sensitive in progression detection, a testing interval of 6 months provides a good balance between early detection of structural progression and the need to selectively allocate limited health care resources (5,6).
Contributor: Sara Giammaria, IRCCS – Fondazione G.B. Bietti, Rome, Italy
1) Leung CK, Cheung CY, Weinreb RN, et al. Retinal nerve fiber layer imaging with spectral-domain optical coherence tomography: a variability and diagnostic performance study. Ophthalmology. 2009;116(7):1257- 1263.
2) Kim KE, Yoo BW, Jeoung JW, Park KH. Long-term reproducibility of macular ganglion cell analysis in clinically stable glaucoma patients. Invest Ophthalmol Vis Sci. 2015;56(8): 4857-4864.
3) Mwanza JC, Chang RT, Budenz DL, et al. Reproducibility of peripapillary retinal nerve fiber layer thickness and optic nerve head parameters measured with cirrus HD-OCT in glaucomatous eyes. Invest Ophthalmol Vis Sci. 2010;51(11):5724- 5730.
4) Bradley C, Hou K, Herbert P, Unberath M, Boland MV, Ramulu P, Yohannan J. Evidence-Based Guidelines for the Number of Peripapillary OCT Scans Needed to Detect Glaucoma Worsening. Ophthalmology. 2023 Jan;130(1):39-47. doi: 10.1016/j.ophtha.2022.07.025. Epub 2022
Aug 3. PMID: 35932839; PMCID: PMC9780153.
5) Melchior B, De Moraes CG, Paula JS, Cioffi GA, Girkin CA, Fazio MA, Weinreb RN, Zangwill LM, Liebmann JM. Frequency of Optical Coherence Tomography Testing to Detect Progression in Glaucoma. J Glaucoma. 2022 Nov 1;31(11):854-859. doi:
10.1097/IJG.0000000000002101. Epub 2022 Aug 11. PMID: 35980865; PMCID: PMC9633358.
6) Mahmoudinezhad G, Moghimi S, Proudfoot JA, et al. Effect of Testing Frequency on the Time to Detect Glaucoma Progression With Optical Coherence Tomography (OCT) and OCT Angiography. Am J Ophthalmol. 2023;245:184-192
Tip of the Month manager: Frances Meier-Gibbons
Tip of the Month editorial board: Francisco Goni, Karl Mercieca, Humma Shahid
Tip of the Month editors in chief: Manuele Michelessi, Francesco Oddone