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Robert N Weinreb

Publications and source records attributed to Robert N Weinreb.

At least 19 recordsLinked to original sources
PubMed2007

Magnetic resonance imaging of the visual system in vivo: transsynaptic illumination of V1 and V2 visual cortex.

Brain nuclei directly receiving retinal projections are readily labeled in magnetic resonance images following intraocular injection of manganese (Mn). To assess whether Mn in retinal ganglion cell axons can be transsynaptically delivered to visual cortex, mice that had previously received intraocular Mn injection were anesthetized with isoflurane, and T1-weighted data sets were acquired of the eyes and brain using a 7-T magnetic resonance imaging machine. Image intensity within contralateral brain structures was evaluated by assessing 1) signal-to-noise ratios, 2) mean image intensity, and 3) mean image intensity normalized to facial muscle intensity. Image intensity was increased throughout the visual pathway including within contralateral visual cortex areas V1 and V2L. Mean normalized image intensity was greater by 53% in the ipsilateral optic nerve and by 31% and 28% in the contralateral lateral geniculate nucleus and superior colliculus, respectively (N=5, P<0.02, paired t test). In contralateral visual cortex areas V1 and V2L, image intensity was increased by 7.5% and 6.8%, respectively (P<0.02 for both, paired t test). Power analysis of the different evaluation methods yielded evidence of superior sensitivity using the normalization method. Reconstruction of the visual system based upon threshold analysis allowed simultaneous visualization of all portions of the major retinal projections to the brain. These results support use of high magnetic field MRI imaging and data normalization for in vivo quantitative analysis of the mouse brain visual system including visual cortex.

Animals↗
PubMed2007

The effects of study design and spectrum bias on the evaluation of diagnostic accuracy of confocal scanning laser ophthalmoscopy in glaucoma.

PURPOSE: To assess the effects of study design and spectrum bias on the evaluation of diagnostic accuracy of confocal scanning laser ophthalmoscopy (CSLO) in glaucoma. METHODS: Analysis 1 included 67 eyes with glaucomatous visual field loss and 56 eyes of normal volunteers. Estimates of diagnostic accuracy in this analysis were compared to those obtained from analysis 2, which included a cohort of patients with suspected glaucoma, but without visual field loss at the time of CSLO imaging. For analysis 2, 40 eyes with progressive glaucomatous optic disc change were included in the glaucoma group and 43 eyes without any evidence of progressive damage to the optic nerve that were observed untreated for an average time of 9.01 +/- 3.09 years were included in the normal group. Areas under the receiver operating characteristic (ROC) curves (AUC) were used to evaluate diagnostic accuracy of CSLO parameters. RESULTS: There was a statistically significant difference between the performance of the parameter with largest AUC, discriminant function Bathija, in analysis 1 (AUC = 0.91) compared with its performance in analysis 2 (AUC = 0.71; P = 0.002). For the contour-line-independent parameter glaucoma probability score, a statistically significant difference was also observed in the performance obtained in analysis 1 (AUC = 0.89) compared with analysis 2 (AUC = 0.65; P < 0.001). CONCLUSIONS: Estimates of diagnostic accuracy of CSLO in glaucoma can be largely different depending on the population studied and the reference standard used to define disease. Diagnostic accuracy estimates obtained from case-control studies including well-defined groups of subjects with or without disease may not be applicable to the clinically relevant population.

Adult↗
PubMed2007

The effect of atypical birefringence patterns on glaucoma detection using scanning laser polarimetry with variable corneal compensation.

PURPOSE: The purpose of this study was to investigate the effect of the presence of atypical birefringence patterns, as measured by the typical scan score (TSS), on the diagnostic accuracy of a scanning laser polarimeter (the GDx VCC; Carl Zeiss Meditec, Inc., Dublin, CA) assessed by receiver operating characteristic (ROC) curves for discriminating between glaucoma and healthy eyes. METHODS: Two hundred thirty-three glaucomatous eyes (repeatable abnormal visual fields by pattern standard deviation [PSD] and/or glaucoma hemifield test [GHT]) from 153 patients with glaucoma and 104 eyes from 71 healthy participants enrolled in the UCSD Diagnostic Innovations in Glaucoma Study (DIGS) were imaged using the GDx VCC. An ROC regression model was used to evaluate the influence of the covariates TSS; disease severity, defined as standard automated perimetry (SAP) mean deviation [MD]; and age in years on the diagnostic accuracy of the GDx parameters nerve fiber indicator [NFI], TSNIT (temporal, superior, nasal, inferior, temporal) average thickness, superior average thickness, inferior average thickness, and TSNIT standard deviation. Areas under the ROC curve were calculated for specific levels of the covariates according to the results provided by the model. RESULTS: TSS and SAP MD significantly affected the diagnostic accuracy of each investigated GDx VCC parameter. Low TSSs, indicating the presence of atypical scans, were associated with decreased accuracy. For NFI, ROC curve areas ranged from 0.749 (when TSS = 20) to 0.904 (when TSS = 100). A similar influence of TSS was found for other parameters. In addition, diagnostic accuracy increased with increasing disease severity. For instance, for NFI, ROC curve areas ranged from 0.853 (when SAP MD = -3) to 0.954 (when SAP MD = -15). CONCLUSIONS: The diagnostic accuracy of GDx VCC parameters is affected by disease severity and is adversely affected by the presence of atypical retardation patterns (i.e., decreasing TSS). GDx VCC scans with atypical scan patterns should be interpreted with caution when used in clinical practice.

Adolescent↗
PubMed2006

Effect of laser trabeculoplasty on nocturnal intraocular pressure in medically treated glaucoma patients.

PURPOSE: To evaluate the effects of laser trabeculoplasty on 24-hour intraocular pressure (IOP) in a group of medically treated open-angle glaucoma patients. DESIGN: Prospective experimental study. PARTICIPANTS: Eighteen open-angle glaucoma patients. METHODS: Laser trabeculoplasty (180 degrees ) was performed on 28 eyes of 18 glaucoma patients. Twenty-four-hour IOP data were collected in a sleep laboratory before and 45 to 80 days after the procedure. Measurements of sitting and supine IOP were taken during the 16-hour diurnal/wake period, and measurements of supine IOP were taken during the 8-hour nocturnal/sleep period in 2-hour intervals. MAIN OUTCOME MEASURES: Changes in the mean, peak, and range of IOP during the office-hour, diurnal, nocturnal, and 24-hour periods. RESULTS: Compared with the baselines, changes in the mean, peak, and range of IOP were not significant during the office-hour period and during the diurnal period in either the sitting or the supine position. The mean, peak, and range of IOP were reduced significantly during the nocturnal period in the supine position. Mean and peak 24-hour IOP were reduced significantly in the habitual body positions (sitting during the diurnal period and supine during the nocturnal period). The reduction of mean 24-hour IOP in the supine position also was significant. CONCLUSIONS: In this group of medically treated open-angle glaucoma patients, laser trabeculoplasty reduced IOP more consistently during the nocturnal period than during the diurnal period.

Adrenergic alpha-Agonists↗
PubMed2006

Comparison of dynamic contour tonometry and goldmann applanation tonometry in African American subjects.

PURPOSE: To evaluate the relationship between intraocular pressure (IOP) measurements obtained by dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) in African Americans and to assess whether these measures were influenced by ocular parameters including corneal thickness, corneal curvature, and axial length. DESIGN: Observational clinical study. PARTICIPANTS: The study included 176 eyes of 94 African Americans. METHODS: All participants underwent IOP evaluation with DCT and GAT, as well as measurements of central corneal thickness (CCT), corneal curvature, corneal astigmatism, spherical equivalent, and axial length. MAIN OUTCOME MEASURES: Univariate and multiple regression analyses were used to evaluate the associations between IOP (as measured with DCT and GAT) and CCT, corneal curvature, corneal astigmatism, spherical equivalent, axial length, and age. Bland-Altman plots were used to evaluate the agreement between IOP measurements obtained by DCT and GAT. RESULTS: In multiple regression analysis, GAT IOP measurements were significantly associated with CCT (P<0.001) and age (P = 0.003), whereas DCT IOP measurements were associated only with age (P = 0.027). The difference between DCT and GAT IOP measurements was significantly influenced by corneal thickness (P<0.001) and ocular pulse amplitude (OPA; P = 0.004). Patients with thick corneas tended to have higher GAT IOP measurements compared with DCT, whereas in patients with thin corneas, GAT IOP measurements tended to be lower than DCT measurements. Larger values of OPA were associated with a decrease in the difference between DCT and GAT measurements, whereas smaller values of OPA were associated with an increase in the difference between DCT and GAT measurements. CONCLUSIONS: Dynamic contour tonometry measurements in African Americans seem to provide an estimate of IOP that is less influenced by corneal properties than those provided by GAT.

Adult↗
PubMed2006

Retinotopic organization of primary visual cortex in glaucoma: Comparing fMRI measurements of cortical function with visual field loss.

Primary open angle glaucoma (POAG) is a progressive optic neuropathy characterized by retinal ganglion cell loss. Experimental primate glaucoma indicates neuronal degeneration of the lateral geniculate nucleus (LGN) and activity changes in the visual cortex (V1). Neuronal degeneration has also been shown in a post-mortem human study of the optic nerve, LGN and visual cortex. Functional magnetic resonance imaging (fMRI), a non-invasive means of inferring function-specific neuronal activity, provides an opportunity to evaluate glaucomatous changes in neuronal activity throughout the visual pathway in vivo. The purpose of this study is to demonstrate that the relationship between visual field loss in human POAG and the functional organization of V1 can be measured using novel fMRI analysis methods. Visual field defects were measured using standard automated perimetry (SAP). A retinotopic map of visual space was obtained for V1, and the retinotopy data was fit with a template. The template was used to project regions within the visual field onto a flattened representation of V1. Viewing through the glaucomatous vs. fellow eye was compared by alternately presenting each eye with a scotoma-mapping stimulus. The resulting blood oxygen level dependent (BOLD) fMRI response was compared to interocular differences in thresholds for corresponding regions of the visual field. The spatial pattern of activity observed in the flattened representation agreed with the pattern of visual field loss. Furthermore, the amplitude of the BOLD response was correlated on a pointwise basis with the difference in sensitivity thresholds between the glaucomatous and fellow eyes (r = 0.53, p < 0.0001). The BOLD signal in human V1 is altered for POAG patients in a manner consistent with the loss of visual function. FMRI of visual brain areas is a potential means for quantifying glaucomatous changes in neuronal activity. This should enhance our understanding of glaucoma, and could lead to new diagnostic techniques and therapies.

Animals↗
PubMed2006

Chronic ocular hypertension induces dendrite pathology in the lateral geniculate nucleus of the brain.

In glaucoma, there is atrophy and loss of retinal ganglion cells (RGC), in addition to atrophy and loss of target neurons in the lateral geniculate nucleus (LGN) of the brain. To investigate possible changes to the dendrites of LGN neurons in glaucoma, a selective marker for dendrites called microtubule-associated protein-2 (MAP2) was used. The LGNs from five monkeys with varying degrees of optic nerve fiber loss were compared to those from five normal control monkeys. Dendrites in magno- and parvocellular layers connected to the glaucomatous eye were evaluated. In controls, long MAP2-positive dendrites with multiple fine branches were seen. However, chronic ocular hypertension induced striking disruption of dendrites with a thickened and shortened appearance. Dendrite field area was significantly reduced in the glaucoma group compared to controls. Sholl analysis revealed reduced dendrite complexity by 47% and 41% in magnocellular layer 1 and parvocellular layer 6, respectively in the glaucoma group compared to controls. The striking dendrite changes in the LGN following chronically elevated intraocular pressure may be relevant to early visual dysfunction in glaucoma.

Animals↗
PubMed2006

Intereye concordance in locations of visual field defects in primary open-angle glaucoma: diagnostic innovations in glaucoma study.

PURPOSE: To determine the overlap in defective visual field locations between the right and left eyes of primary open-angle glaucoma patients. DESIGN: Cross-sectional retrospective analysis of data from a prospectively designed longitudinal study. PARTICIPANTS: Patients with glaucomatous optic neuropathy in at least 1 eye and 2 consecutive reliable standard automated perimetry fields within 15 months were included, yielding 468 eyes of 234 patients. METHODS: Concordance in defective visual field locations between right and left eyes were calculated as the number of overlapping locations divided by the total number of defective locations (intereye concordance ratio). Concordance ratios also were calculated within an eye over time (intraeye concordance ratio) and between unmatched pairs of fields (unmatched concordance ratio). RESULTS: Intereye concordance (0.24+/-0.02) was significantly smaller than intraeye concordance (0.37+/-0.02) and significantly larger than unmatched concordance (0.14+/-0.01). There was a significant interaction between concordance type and defect size, such that there was no difference in concordance ratios for defects of fewer than 8 locations, and the difference between intereye concordance versus intraeye concordance and unmatched concordance ratios increased with larger defect sizes. CONCLUSIONS: A spatial relationship exists between defective locations of an individual's eyes. Future studies will show whether information about the spatial relationship is useful to guide the modification of visual field test locations to improve detection of loss and perhaps also progression.

Adult↗
PubMed2006

Comparison of invasive and non-invasive tonometry in the mouse.

Assessment of the accuracy of non-invasive rebound tonometry, and comparison with invasive cannulation tonometry. An in vivo calibration technique was devised to improve the accuracy of the rebound tonometer. IOP was then measured in SW mice using both rebound and cannulation tonometry. The ability of the rebound tonometer to accurately measure small IOP reductions after instillation of a topical prostaglandin was also determined. With the rebound method, mid-afternoon IOP in two groups of similar aged SW mice was 15.9+/-3.9 mmHg (mean+/-s.d., n=25) compared to 16.3+/-1.2 mmHg (n=32) using the cannulation technique. This difference was not statistically significant (p=0.6). For serial measurements using both techniques in the same eyes of a third group of SW mice (n=14), mean IOP was 15.0+/-3.9 mmHg for rebound tonometry but only 13.4+/-2.3 mmHg for subsequent cannulation tonometry. This effect was subsequently shown to be a consequence of the rebound tonometry, as multiple rebound measurements induced a statistically significant reduction in IOP. The average IOP reduction observed 2 hr after a single application of topical latanoprost (200 ng) was 2.8+/-1.3 mmHg (p<0.001) and 2.4+/-4.7 mmHg (p=0.03) with cannulation and rebound tonometers, respectively. These differences were not significantly different (p=0.8). In vivo calibration of the rebound tonometer increased measurement accuracy and provided IOP values within the physiological range that agreed closely with the IOP measured by cannulation tonometry. However, IOP measurement with the rebound tonometer had larger variability compared with the cannulation method. Repeat IOP measurements with the rebound tonometer led to a reduction in IOP. The rebound tonometer was sufficiently sensitive to detect a 2-3 mmHg reduction in IOP following application of topical latanoprost. Despite these limitations, the rebound tonometer has a significant advantage over cannulation tonometry in that it permits longitudinal IOP measurement in conscious mice.

Administration, Topical↗
PubMed2006

Asymmetry of right versus left intraocular pressures over 24 hours in glaucoma patients.

PURPOSE: To assess the asymmetry of 24-hour intraocular pressures (IOPs) between right and left eyes of untreated open-angle glaucoma (OAG) patients, and its influence on the monocular therapeutic trial. DESIGN: Experimental study with human patients. PARTICIPANTS: Forty-one subjects (40-78 years old) with untreated OAG. METHODS: Subjects were housed in a sleep laboratory for 24 hours. Intraocular pressures of both eyes were measured with a pneumatonometer every 2 hours with the patient in the sitting and supine positions from 7 am to 11 pm and in the supine position only from 11 pm to 7 am. Mean, peak, and trough IOPs were compared in right versus left eyes. The strength of association between right and left IOPs was assessed using coefficients of determination (R2). Validity of the monocular therapeutic trial was assessed by examining residual values from 2 linear regression models of right versus left IOP. MAIN OUTCOME MEASURES: Strength of association between IOPs of right and left eyes, and residual values from linear models of IOP. RESULTS: No statistically significant difference was found between mean, peak, or trough IOPs of right and left eyes over a 24-hour period. The strength of association for mean IOP was only moderate (R(2) = 0.421-0.623). Residual values of > or =3 mmHg were found in 14.0%+/-12.0% (mean +/- standard deviation) of IOP measurements for a symmetric linear regression model, and 8.5%+/-10.6% of IOP measurements for a best-fit linear regression model over 24 hours. CONCLUSIONS: In this group of untreated glaucoma patients, the strength of association between the right and left eye mean IOPs is only moderate. Residual values of > or =3 mmHg were more common using a symmetric model than with a best-fit model. The current method of performing monocular therapeutic trials in glaucoma patients is unreliable, but it may be possible to improve reliability by using several IOP measurements obtained at different times of the day instead of a single office measurement.

Adult↗
PubMed2006

Memantine protects neurons from shrinkage in the lateral geniculate nucleus in experimental glaucoma.

OBJECTIVE: To determine whether memantine as a treatment for glaucoma prevents neuron shrinkage in the lateral geniculate nucleus, the major target for retinal ganglion cells. METHODS: Sixteen monkeys with right-eye unilateral experimental glaucoma for 14 months were studied and treated with memantine (n = 9) or vehicle only (n = 7). Left lateral geniculate nucleus relay neurons (layers 1, 4, and 6) were examined following parvalbumin immunolabeling. Cell body cross-sectional areas and neuron numbers were assessed using unbiased methods. Memantine- and vehicle-treated glaucoma groups were compared using t tests and analysis of covariance. RESULTS: Compared with vehicle-treated animals, memantine-treated animals showed significantly less mean +/- SD neuron shrinkage in layers 1 (-4.0% +/- 13.9% vs 28.2% +/- 17.4%; P = .001) and 4 (24.9% +/- 10.0% vs 37.2% +/- 12.3%; P = .04). For layer 6, the difference was not statistically significant (34.2% +/- 10.1% vs 45.3% +/- 14.5%; P = .10). Analysis of covariance results showed significantly less neuron shrinkage in the memantine-treated group for layers 1, 4, and 6 (P < .001; P < .02; and P < .04, respectively). This difference was greatest in layer 1. In each of these layers, neuron numbers did not differ significantly between groups. CONCLUSION: Monkeys with glaucoma that were treated with memantine showed significantly less neuron shrinkage in the lateral geniculate nucleus than the vehicle-treated glaucoma group. CLINICAL RELEVANCE: The finding that memantine protects adult visual neurons from transsynaptic atrophy in experimental glaucoma could have therapeutic value. Currently, memantine is being tested in an ongoing clinical trial as a treatment for glaucoma.

Animals↗
PubMed2006

Relationship between patterns of visual field loss and retinal nerve fiber layer thickness measurements.

PURPOSE: To investigate the association between patterns of visual field (VF) loss and retinal nerve fiber layer (RNFL) thickness measurements. DESIGN: Observational cross-sectional study. METHODS: One hundred twenty-one glaucoma patients and 65 healthy subjects from the Diagnostic Innovations in Glaucoma Study (DIGS) were included. All glaucoma patients had repeatable abnormal VFs and scanning laser polarimetry (SLP) RNFL thickness measurements. RNFL measurements were obtained from 16 equal parapapillary sectors. Patterns of VF loss were classified as arcuate, partial arcuate, nasal step, or paracentral in each VF hemifield. Logistic regression analysis was performed to determine which RNFL sectors were associated with each VF pattern. The ability of SLP to discriminate between eyes with different VF patterns and healthy eyes using receiver operating characteristic (ROC) curve analyses also was investigated. RESULTS: VF patterns in the superior hemifield were significantly associated with RNFL sectors in the temporal inferior hemiretina (P < .05). ROC curve areas for discrimination between eyes with different VF patterns and healthy eyes ranged from 0.85 to 0.95. VF patterns in the inferior hemifield were most strongly associated with temporal superior RNFL sectors (P < .05). ROC curve areas for discrimination between different VF patterns and healthy eyes ranged from 0.73 to 0.98. SLP could discriminate between apparently unaffected VF hemifields in glaucoma eyes and VF hemifields in healthy eyes. CONCLUSIONS: Parapapillary RNFL thickness was topographically related to patterns of VF loss. SLP can differentiate between apparently unaffected VF hemifields in glaucoma eyes and normal VF hemifields in healthy eyes.

Aged↗
PubMed2006

Inter-eye comparison of patterns of visual field loss in patients with glaucomatous optic neuropathy.

PURPOSE: To compare inter-eye patterns of visual field (VF) loss on standard automated perimetry (SAP) in patients with glaucomatous optic neuropathy. DESIGN: Observational cross-sectional study. METHODS: Four-hundred-and-ninety eyes of 245 patients with glaucomatous optic neuropathy in at least one eye defined by masked stereophoto review were included. Patients had two reliable SAP visual fields within fifteen months for each eye. Patterns of visual field loss were classified independently by two graders masked to all other patient information. Patterns were described as altitudinal, arcuate, partial arcuate, paracentral, nasal step, temporal wedge, or normal based on the classification system of Keltner and associates. Superior and inferior hemifields were graded separately. RESULTS: Inter-grader agreement in visual field patterns before adjudication was 97% and 94% for the worse eye (superior and inferior hemifield) and 97% and 95% for the better eye (superior and inferior hemifield). The percentage of correspondence by hemifield location was: 53% (superior-superior), 62% (inferior-inferior), 45% (superior-inferior), and 55% (inferior-superior). The highest correspondence of individual glaucomatous VF pattern between eyes was for arcuate (superior-superior) and inferior partial arcuate (inferior-inferior) defects (24% and 26%, respectively). Smaller hemifield patterns showed lower correspondence between the eyes (nasal step, paracentral, temporal wedge, 0% to 13% correspondence). CONCLUSIONS: Patterns of visual field loss between eyes often corresponded within the same VF hemifield (superior-superior, inferior-inferior) as well as between opposite hemifields (inferior-superior), although opposite hemifield correspondence was less common. More advanced visual field defects (for example, partial arcuate) showed higher correspondence rates between the eyes than less advanced defects.

Aged↗
PubMed2006

Sustained effect of travoprost on diurnal and nocturnal intraocular pressure.

PURPOSE: To assess the diurnal and nocturnal persistency of intraocular pressure (IOP) reduction after omission of up to two doses of once-daily topical travoprost in patients with open-angle glaucoma or ocular hypertension. DESIGN: Prospective, open-label study. METHODS: Twenty subjects underwent three sessions of 24-hour IOP monitoring. The first session occurred before initiating treatment of newly diagnosed patients or after a four-week washout in patients already receiving medical therapy. The second session occurred after four weeks or more of travoprost treatment. The third session was performed 41 to 63 hours after the last travoprost dose. RESULTS: IOP lowering persisted after omission of one to two doses. Between 41 to 63 hours after the last dose, diurnal IOP reduction was attenuated, but nocturnal IOP reduction sustained. CONCLUSIONS: IOP lowering effect after omission of one to two doses of travoprost is attenuated in the diurnal period but sustained in the nocturnal period, the time corresponding to the highest baseline habitual IOP.

Aged↗
PubMed2006

Agreement and repeatability for standard automated perimetry and confocal scanning laser ophthalmoscopy in the diagnostic innovations in glaucoma study.

PURPOSE: To assess agreement between structural and functional testing in classifying eyes as normal or abnormal and their repeatability on two consecutive visits by means of standard automated perimetry (SAP) and confocal scanning laser ophthalmoscopy. DESIGN: Analysis of selected data obtained from a prospective longitudinal observational cohort study, the Diagnostic Innovations in Glaucoma Study. METHODS: One hundred fifty-one participants with a SAP and a Heidelberg Retina Tomograph (HRT) test within a three-month window at two visits within 15 months were included. Eyes were classified by SAP and HRT at each visit. Agreement and repeatability were assessed by kappa statistics. RESULTS: At visit 1, 33 (22%) of 151 eyes had only SAP defects, 11 (7%) eyes had only HRT defects, and 35 (23%) eyes had both SAP and HRT defects. Seventy-two eyes (48%) were classified as normal by both tests. Similar results were obtained for visit 2. The agreement between SAP and HRT in classifying eyes was 70% (kappa = 0.393) at visit one and 68% (kappa = 0.363) at visit 2. Repeatability of classification by SAP alone, HRT alone, and both SAP and HRT between visits 1 and 2 was 84% (kappa = 0.693), 89% (kappa = 0.752), and 90% (kappa = 0.723), respectively. CONCLUSIONS: Agreement between SAP and HRT was only fair at both visits. Repeatability across visits was substantial for SAP alone, HRT alone, and for the combination of SAP and HRT. These results suggest that detection of particular features of glaucomatous damage depends on the technique used. Structural and functional tests appear complementary, and both should be used for early detection of glaucoma.

Female↗
PubMed2006

Baseline optical coherence tomography predicts the development of glaucomatous change in glaucoma suspects.

PURPOSE: To assess whether baseline retinal nerve fiber layer (RNFL) measurements obtained with optical coherence tomography (OCT2; Carl Zeiss Meditec, Dublin, California, USA) are predictive of the development of glaucomatous change. DESIGN: Cohort study. METHODS: Participants were recruited from the University of California, San Diego (UCSD) longitudinal Diagnostic Innovations in Glaucoma Study (DIGS). One eye was studied from each of 114 glaucoma suspects with normal standard automated perimetry (SAP) and OCT RNFL imaging at baseline. The cohort was divided into two groups based on the development of glaucomatous change (repeatable abnormal visual fields and/or a change in the stereophotographic appearance of the optic disk). Cox proportional hazards models were used to determine the predictive ability of OCT RNFL thickness measurements. RESULTS: Over a 4.2-year average follow-up period, 23 eyes (20%) developed glaucomatous changes and 91 (80%) did not. At baseline, thinner RNFL measurements, higher SAP pattern standard deviation (PSD), "glaucoma" stereophotograph assessment, and thinner central corneal thickness (CCT) were associated with the study endpoints in univariate analysis. After adjusting for age, intraocular pressure (IOP), CCT, and PSD in multivariate models, a 10 mum thinner average, superior and inferior RNFL at baseline was predictive of glaucomatous change [hazard ratio (95% CI); 1.51 (1.11 to 2.12), 1.57 (1.17 to 2.18), and 1.49, (1.19 to 1.91), respectively]. Results were consistent when stereophotographic assessment was included in multivariate analysis. CONCLUSIONS: Thinner OCT RNFL measurements at baseline were associated with development of glaucomatous change in glaucoma suspect eyes. RNFL thinning was an independent predictor of the glaucomatous change, even when adjusting for stereophotograph assessment, age, IOP, CCT, and PSD.

Cohort Studies↗