Visual Field Progression Rate and Laminar Depth and Curvature in the African Descent and Glaucoma Evaluation Study (ADAGES)

PURPOSE: To evaluate whether lamina cribrosa (LC) depth and curvature predict visual field (VF) progression in primary open-angle glaucoma (POAG) patients. METHODS: Anterior laminar cribrosa surface depth (ALCSD) and LC curvature index (LCCI) were defined by spectral domain optic coherence tomographic (SDOCT) images. All scans were processed using a deep learning software to perform layer segmentation. Linear mixed-effects models were used to test associations between VF progression rate, ALCSD, and other demographic and clinical characteristics and known risk factors for progressive POAG. RESULTS: A total of 584 eyes from 359 POAG patients were analyzed, comprising 167 African Descent (AD) eyes (292 eyes) and 192 European Descent (ED) eyes (292 eyes). There was a statistically significant relationship between faster VF progression rates, and a deeper ALCSD (-0.02 dB/year/50 µm, P < 0.001) and LCCI (-0.01 dB/year/unit, P < 0.001). There was also increasing progression seen in both models with increasing age (-0.025 dB/year/10 years, P < 0.007), intraocular pressure (IOP) (-0.011 dB/year per 2 mm Hg, P = 0.021), and disease severity (0.017 dB/year per dB, P < 0.001). The rate of progression was faster in the ED (used as the reference group) cohort (-0.056 dB/year, P = 0.006) following propensity matching for disease severity and age. CONCLUSIONS: In our cohort, there was a statistically significant association between VF rate and ALCSD and curvature (LCCI). A 50 µm deeper LC at baseline had a similar effect on VF progression as being 10 years of age or older. TRANSLATIONAL RELEVANCE: LC depth and curvature may serve as structural biomarkers to identify patients with glaucoma at a higher risk of progression.