Aim. To investigate the ability of Heidelberg Retina Tomograph (HRT3) Topographic Change Analysis (TCA) map to predict the subsequent development of clinical change, in patients with glaucoma. Materials. 61 eyes of 61 patients, which, from a retrospective review were defined as stable on optic nerve head (ONH) stereophotographs and visual field (VF), were enrolled in a prospective study. Eyes were classified as TCA-stable or TCA-progressed based on the TCA map. All patients underwent HRT3, VF, and ONH stereophotography at 9–12 months intervals. Clinical glaucoma progression was determined by masked assessment of ONH stereophotographs and VF Guided Progression Analysis. Results. The median (IQR) total HRT follow-up period was 8.1 (7.3, 9.1) years, which included a median retrospective and prospective follow-up time of 3.9 (3.1, 5.0) and 4.0 (3.5, 4.7) years, respectively. In the TCA-stable eyes, VF and/or photographic progression occurred in 5/13 (38.4%) eyes compared to 11/48 (22.9%) of the TCA-progressed eyes. There was no statistically significant association between TCA progression and clinically relevant (photographic and/or VF) progression (hazard ratio, 1.18; ). The observed median time to clinical progression from enrollment was significantly shorter in the TCA-progressed group compared to the TCA-stable group ( ). Conclusion. Our results indicate that the commercially available TCA progression criteria do not adequately predict subsequent photographic and/or VF progression. 1. Introduction Accurate assessment of structural and functional change in glaucoma is important for diagnosis and progression detection. In current clinical practice, functional progression is monitored by standard automated perimetry (SAP). Structural progression is subjectively determined by clinical evaluation of optic nerve head (ONH) stereophotographs [1–4]. Results from the Collaborative Initial Glaucoma Treatment Study (CIGTS) and Ocular Hypertension Treatment Study (OHTS) support the view that optic disc change may be a more sensitive indicator of glaucomatous progression than VF change in patients with glaucoma or ocular hypertension (OHT) [5, 6]. However, in many cases VF defects were the first sign of glaucomatous development in OHT eyes [5]. Objective technologies such as the Heidelberg Retina Tomograph (HRT, Heidelberg Engineering, GmbH, Dossenheim, Germany) have been developed as adjuncts to subjective ONH evaluation. The HRT is a confocal scanning laser tomography device that creates reproducible and repeatable three-dimensional topographic images of the ONH
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