Enhanced Detection of Glaucoma Progression Using Widefield Swept-Source OCT

Marc G Sarossy; Maxime Jannaud; Xavier Hadoux; Sandy Rezk; Dongzhe Li; Michael A Coote; Ghee Soon Ang; Joana Galvao; Peter van Wijngaarden; Keith R Martin; Zhichao Wu

doi:10.1016/j.ogla.2025.09.007

Enhanced Detection of Glaucoma Progression Using Widefield Swept-Source OCT

Ophthalmol Glaucoma. 2025 Sep 22:S2589-4196(25)00193-0. doi: 10.1016/j.ogla.2025.09.007. Online ahead of print.

Authors

Affiliations

¹ Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia.
² Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.
³ Ophthalmology I2O, F Hoffmann-La Roche AG, Basel, Switzerland.
⁴ Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia. Electronic address: wu.z@unimelb.edu.au.

PMID: 40992505
DOI: 10.1016/j.ogla.2025.09.007

Abstract

Purpose: To examine the effectiveness of evaluating widefield swept-source OCT scans for detecting glaucoma progression compared with conventional circumpapillary retinal nerve fiber layer thickness (cpRNFLT) measurements.

Design: Longitudinal study.

Participants: One hundred and fifty-six eyes with glaucoma from 115 participants.

Methods: This study included individuals seen over ≥2 visits that were 12 months apart and those who were also scheduled for retest visits within ≤1 month at the baseline and 12-month visits. A circumpapillary circle scan on spectral-domain OCT and a widefield 15×15 mm OCT volume scan were acquired from each eye at each visit. A total of 286 and 284 unique visit pairs were thus available, where OCT scans were obtained 12 months and ≤1 month apart respectively, serving as the case and control groups respectively. Widefield OCT scans from these visit pairs were evaluated by 2 graders, who assessed the ganglion cell complex (GCC) thickness and thickness difference maps for glaucoma progression, masked to the time difference between the 2 scans.

Main outcome measures: Percentage of eyes deemed as progressing at 95% specificity.

Results: Evaluation of widefield OCT scans identified >2 times as many eyes as progressing over a 12-month period (Grader 1 = 36.7%; Grader 2 = 38.1%) than cpRNFLT measurements from spectral-domain OCT (16.8%; P < 0.001 for both) at 95% specificity. For the subset of 96 (62%) eyes with a baseline visual field mean deviation (MD) ≥-6 dB, evaluation of widefield OCT scans identified ≥3 times as many eyes as progressing (Grader 1 = 41.1%; Grader 2 = 46.3%) compared with cpRNFLT measurements (13.7%; P < 0.001 for both). There was substantial between-grader agreement for the eyes identified as progressing on widefield OCT imaging (Gwet first-order agreement coefficient = 0.76). Evaluation of widefield OCT scans in a 2-arm trial seeking to detect a ≥30% treatment effect in 1 study eye, with 80% power, was estimated to reduce sample size requirements by 69% compared with cpRNFLT measurements, or by 80% when only including eyes with an MD ≥-6 dB.

Conclusions: Qualitative evaluation of widefield OCT scans showed an enhanced detection rate for structural progression than cpRNFLT measurements in glaucoma eyes.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Ganglion Cell Complex; Glaucoma; OCT; Progression; Widefield.