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The effect of test variability on the structure–function relationship in early glaucoma

  • Glaucoma
  • Published:
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Abstract

Purpose

To determine whether the weakness of the structure–function relationship could be produced by test variability alone, without implying underlying dissociation between the true rates of structural and functional change.

Methods

Perimetric mean deviation (MD), and rim area (RA) and cup volume (CV) from confocal scanning laser ophthalmoscopy, over six visits, were taken from 166 eyes of 92 participants with high-risk ocular hypertension or suspected/early glaucoma in the Portland Progression Project. Models were created of each measure’s variability. A further model predicted the rate of functional change from the rate of structural change. These were used to generate realistic simulated sequences of both functional and structural data with different standard deviations σ between the underlying rates of change. ‘Observed’ structure–function relationships were calculated. An empirical p-value was derived, equaling the proportion of simulated series for which the ‘observed’ structure–function dissociation was greater than that seen in patient data.

Results

The correlation between the rates of structural (RA) and functional (MD) change was 0.171, consistent with σ < 0.02 dB/yr. Using CV, the correlation was −0.091, consistent with σ < 0.01 dB/yr. By comparison, the models predicted that the standard deviation of the rate of functional change for a healthy eye due to test variability would be 0.18 dB/yr.

Conclusion

Test variability is sufficiently large that realistic patient data can be simulated without requiring a large variability between the underlying rates of structural and functional change. This absence of implied dissociation is a necessary condition for it to be valid to combine structural and functional measures to improve estimates of functional change and/or to reduce perimetric variability.

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Authors and Affiliations

  1. Discoveries In Sight Laboratories, Devers Eye Institute, Legacy Health System, 1225 NE 2nd Ave, Portland, OR, 97232, USA

    Stuart K. Gardiner & Shaban Demirel

  2. Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA

    Chris A. Johnson

Authors
  1. Stuart K. Gardiner
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  2. Chris A. Johnson
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  3. Shaban Demirel
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Correspondence to Stuart K. Gardiner.

Additional information

This project was funded in part by NIH grants NEI R01-EY-03424 (to author CAJ) and NEI R01- EY-019674 (to author SD). No authors have any financial/conflicting interests to disclose. The authors have full control of all primary data, and agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review the data if requested.

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Gardiner, S.K., Johnson, C.A. & Demirel, S. The effect of test variability on the structure–function relationship in early glaucoma. Graefes Arch Clin Exp Ophthalmol 250, 1851–1861 (2012). https://doi.org/10.1007/s00417-012-2005-9

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  • DOI: https://doi.org/10.1007/s00417-012-2005-9

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