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Macular Damage in Early Glaucoma and Progression

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ClinicalTrials.gov Identifier: NCT02547740
Recruitment Status : Recruiting
First Posted : September 11, 2015
Last Update Posted : November 8, 2022
National Eye Institute (NEI)
Information provided by (Responsible Party):
Columbia University

Brief Summary:

Glaucoma is the leading cause of irreversible blindness worldwide. This study aims to test a new method that may allow earlier diagnosis of glaucoma and better ways to monitor if it is getting worse. There is scientific evidence that the macula, the central part of the retina, can be involved in very early stages of glaucoma. Glaucomatous damage to the macula is very prevalent and is often missed using conventional clinical tests.

Relatively little is known about progression of early glaucoma damage and its effects on the macula. This project investigates the nature of progressive damage to the macula and proposes new methods to improve accuracy to detect clinically significant progression.The study will evaluate the nature of damage to the macula's structures through OCT imaging and eye function via visual field tests.

Condition or disease

Detailed Description:

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.

The main hypothesis is that incorporating 10-2 visual field testing and high-resolution OCT scans of the macula to the conventional repertoire of technologies used in clinical practice, in addition to translating recently described statistical methods into softwares that can be used in daily practice, enhances the performance and confidence to detect glaucoma progression.

In Aim 1 the investigators plan to follow healthy subjects and glaucoma patients at regular intervals with 10-2, 24-2 visual fields, and swept source (ss) OCT tests and define metrics of short- and long-term test variability that are needed to differentiate true progression from 'noise'. To date, there is no such database combining these technologies.

In Aim 2 the investigators plan to combine metrics of structure and function from this longitudinal database using two methods: a spatial approach, which will ultimately produce a joint structure-function index using 10-2 and ssOCT data; and a temporal approach, which will employ Bayesian statistics to measure rates of progression using trend analysis. By the end of the study, our contributions to the field should be:

  1. to make available a unique and pristine longitudinal database that could be used for other hypotheses testing,
  2. to translate techniques recently described in the literature into objective tools to be readily useful in clinical practice, and
  3. to mitigate the burdens of progressive loss of central vision in glaucoma.

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Study Type : Observational
Estimated Enrollment : 375 participants
Observational Model: Case-Control
Time Perspective: Prospective
Official Title: Structural and Functional Progression of Glaucomatous Damage to the Macula
Actual Study Start Date : October 2015
Estimated Primary Completion Date : October 2023
Estimated Study Completion Date : December 2023

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Glaucoma

Early Glaucomatous Damage
Patients with early functional glaucomatous damage.
Ophthalmologically Healthy
Healthy subjects that are ophthalmologically normal

Primary Outcome Measures :
  1. Change in 10-2 visual field [ Time Frame: Baseline and 3 years ]
    Evidence of functional glaucomatous damage on the macula as confirmed by visual fields: A slope of 10-2 visual field change faster than -1 dB/year at P<5%

  2. Change in macular ganglion cell thickness [ Time Frame: Baseline and 3 years ]
    Evidence of structural glaucomatous damage on the macula as confirmed by OCT imaging: evidence of macular ganglion cell thickness slope less than -10 microns/year

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
Patients seen in Columbia eye clinics and enrolled in cross-sectional database; Columbia University Medical Center Eye Institute.

Glaucoma Group:

Inclusion Criteria:

  • glaucomatous optic neuropathy (as defined in the American Academy of Ophthalmology Preferred Practice Pattern criteria)

Exclusion Criteria:

  • late functional glaucomatous damage
  • significant cataract
  • previous ocular surgery (aside from uncomplicated cataract extraction with intraocular lens (IOL) implantation and/or trabeculectomy, LASIK or refractive surgeries)
  • diabetic retinopathy with macular edema
  • vein or artery occlusion
  • exudative age-related macular degeneration or geographic atrophy
  • macular hole or traction
  • amblyopia
  • uveitis
  • non-open angle glaucoma (e.g. angle closure, traumatic, congenital glaucoma)
  • severe myopia or hyperopia (refractive error greater than -6 or +6D, respectively)
  • retinal detachment (current or post-surgery)
  • retinitis pigmentosa
  • significant epiretinal memberane
  • significant kerotoconus

Healthy Group:

Inclusion Criteria:

  • best corrected visual acuity equal or better than 20/40
  • normal biomicroscopy examination
  • gonioscopically open angles
  • Intraocular Pressure (IOP) lower than 22 mmHg
  • normal and reliable 24-2 and 10-2 SAP results

Exclusion Criteria:

  • evidence of optic neuropathy
  • evidence of clinically significant metabolic diseases (e.g. diabetes and hypotension)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02547740

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Contact: Lam Lu, BS 646-457-0940 ll3051@cumc.columbia.edu

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United States, New York
CUIMC Harkness Eye Institute Recruiting
New York, New York, United States, 10032
Contact: Lam Lu, BS    646-457-0940    ll3051@cumc.columbia.edu   
Sponsors and Collaborators
Columbia University
National Eye Institute (NEI)
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Principal Investigator: Jeffrey Liebmann, MD Columbia University
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Columbia University
ClinicalTrials.gov Identifier: NCT02547740    
Other Study ID Numbers: AAAO8502
1R01EY025253-01 ( U.S. NIH Grant/Contract )
First Posted: September 11, 2015    Key Record Dates
Last Update Posted: November 8, 2022
Last Verified: November 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Columbia University:
visual fields
optical coherence tomography
glaucoma progression
retinal ganglion cells
Additional relevant MeSH terms:
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Disease Progression
Ocular Hypertension
Eye Diseases
Disease Attributes
Pathologic Processes