Baseline Macular OCT Thickness of Ocular Hypertensive Patients Improves Prediction of Glaucoma
In brief
Macular OCT improved glaucoma-risk prediction; 14% developed visual-field damage
In this retrospective study of 330 eyes with ocular hypertension, 47 (14%) developed repeatable visual-field damage over a median 4.4 years. Thinner macular tissue improved the risk calculator's ability to distinguish who would convert, while overall retinal nerve fiber thickness did not; whether this added predictive value changes clinical decisions remains unknown.
- Journal
- American journal of ophthalmology (Q1)
- Published
- 5 November 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Mauro Gobira, Takashi Nishida, Sasan Moghimi, Gizem Dogan Gokce, Melika Hashemi, Ghazaleh Soltani, et al.
- PMID
- 42987995
- DOI
- 10.1016/j.ajo.2026.11.003
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 9 November 2026): OCT improves glaucoma conversion risk prediction
Abstract
PURPOSE: To determine whether baseline macular ganglion cell-inner plexiform layer (GCIPL) and circumpapillary retinal nerve fiber layer (cpRNFL) thickness add prognostic value for glaucomatous visual field (VF) damage in patients with ocular hypertension. DESIGN: Retrospective clinical cohort study. PARTICIPANTS: 330 eyes of 235 patients with ocular hypertension, defined by intraocular pressure of 22 mmHg or higher or an International Classification of Diseases coded diagnosis, without repeatable glaucomatous VF damage at baseline. Eyes came from both the African Descent and Glaucoma Evaluation Study and a clinical cohort at the Shiley Eye Institute. METHODS: Baseline GCIPL and cpRNFL thickness were measured from the first good-quality Cirrus optical coherence tomography (OCT) macular and optic-disc cubes. Clinical predictors were assessed with the Ocular Hypertension Treatment Study (OHTS)-European Glaucoma Prevention Study (EGPS) Risk Calculator. Repeatable glaucomatous VF damage required a Glaucoma Hemifield Test outside normal limits or a pattern standard deviation at the 5% level or worse on three consecutive reliable Humphrey 24-2 examinations. MAIN OUTCOME MEASURES: Hazard ratios per 1 standard deviation (SD) of thinner global and sectoral GCIPL or cpRNFL, and the change in the Harrell concordance (C) index (ΔC) after adding each measure to the Risk Calculator. RESULTS: Glaucomatous VF damage developed in 47 of 330 eyes (14%) over a median 4.4 years. Adjusted for the Risk Calculator, thinner macular GCIPL was associated with conversion (hazard ratio [HR] 1.89 per 1-SD thinner; 95% confidence interval [CI], 1.50 to 2.37; P < .001), and every macular sector was significant (HR 1.71 to 2.02). The Risk Calculator alone showed modest discrimination (Harrell C-index, 0.57). Adding macular GCIPL improved discrimination (ΔC +0.101; 95% CI, +0.022 to +0.220). Global cpRNFL thickness did not improve discrimination (ΔC +0.004; 95% CI, -0.021 to +0.133); among cpRNFL quadrants, only the inferior quadrant was associated with conversion (HR 1.50; 95% CI, 1.02 to 2.22). CONCLUSIONS: In patients with ocular hypertension, thinner baseline macular GCIPL was associated with glaucomatous VF damage and improved the discrimination of the OHTS-EGPS Risk Calculator, whereas global cpRNFL thickness did not.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.