Structural and Functional Progression of Glaucomatous Damage to the Macula

There is compelling evidence that glaucomatous damage to the macula occurs even in early stages of the disease. The macula comprises about 30% of all retinal ganglion cells and its information corresponds to over 50% of the visual cortex. However, glaucomatous damage to the macula is often missed in clinical practice. Some of the reasons are:

1. traditional glaucoma knowledge supports that glaucoma is fundamentally a peripheral disease;
2. inherent limitations of conventional clinical tests to detect damage to the macula; and
3. the paucity of large, prospective studies that describe the nature of glaucomatous damage to the macula.

The investigators have published numerous papers in the past two years showing that macular damage is prevalent among patients with early glaucoma if one employs the appropriate tools to assess it, namely 10-2 visual fields and high-resolution optical coherence tomography (OCT). This information comes from a unique prospective cross- sectional database and techniques the investigators developed to produce objective metrics of structure and function.

Now that the investigators understand the cross-sectional nature of macular damage, this proposal aims to:

1. develop a longitudinal database including patients with early glaucoma and healthy controls,
2. to test models that explain progression of macular damage, and
3. to apply new statistical methods combining structural and functional tests which could improve the accuracy to detect progression and shorten the length of clinical trials.