The Application Of Estimated Retinal Ganglion Cells In Evaluate The Glaucoma Research

Objectives:To integrate structure and function parameters of glaucoma and get the estimated glaucoma Retinal Ganglion Cell (RGC) counts. To explore and analyze the effectiveness of estimated RGC counts in classification and value progression in glaucoma.Methods:The study included two parts. The first part is the cross-sectional study, icluding 140 eyes of 140 patients with glaucoma 110 eyes and 30 healthy individuals. The second part is the prospective study.The follow-up group including 20 eyes of 20 patients with POAG checked once every 6 months, followed up for 2 years or above to check more than five times.All eyes underwent testing with standard automated perimetry (SAP) and spectral-domain optical coherence tomography (SD-OCT). Estimates of retinal ganglion cell (RGC) counts were obtained from SAP and SD-OCT using a previously derived algorithm. Smoothing spline curves were fitted to investigate the relationship between functional/structural parameters and RGC counts. The first derivatives (i.e., slopes) of these curves were obtained to investigate the relationship between changes in these measures. Five times follow-up estimatesd RGC counts do curve and compare with Humphrey VFI perimeter linear regression trend.Results:The difference between Glaucoma patients estimated RGC and normal was statistically significant (P= 0.001).A nonlinear relationship (R2=0.92, P<0.05) was observed between SAP mean deviation (MD) and RGC counts. The average value of normal estimated RGC is:(25.5+5.9)×105, before the vision for glaucoma group: (18.6+3.1) × 105, the early stage group:(12.4+12.4) × 105, medium-term group: (7.4+7.4) × 105, the late stage group:(2.6+2.6) × 105.The same amount of RGC loss corresponded to largely different amounts of MD change depending on the stage of the disease. A nonlinear relationship (R2=0.91, P<0.05)was observed between SAP visual field index (VFI) and RGC counts. The average value of normal VFI is::(98±1)%, before the vision for glaucoma group:(98±2)%, the early stage group:(90±6)%, medium-term group:(70±12)%, the late stage group:(24 ±18)%。.The same amount of RGC loss corresponded to largely different amounts of VFI change depending on the stage of the disease.For SD-OCT average retinal nerve fiber layer (RNFL) thickness, a nonlinear relationship (R2=0.68,P<0.05) was seen with RGC counts. The average value of normal RNFL is:103.8±12.7um, before the vision for glaucoma group:79.3±7.2um, the early stage group:76.2±14.2um, medium-term group:66.7±14.6um, the late stage group:51.9±12.1um。The same amount of RGC loss corresponded to largely different amounts of RNFL thickness change depending on the stage of the disease. Changes in RGC counts for eyes with early damage corresponded to small changes in MD and VFI, but to relatively larger changes in RNFL thickness. For eyes with advanced disease, changes in RGC counts produced relatively larger changes in MD、VFI and RNFL thickness. In the follow-up study, the trend of estimated RGC counts curve shown high consistency in analysis with VFI.Conclusions:The estimated RGC counts change is closely related to the change of the structure and function in patients with glaucoma, it is of great significance to staging glaucoma. the preliminary judgment that estimated RGC counts can effectively describe the progression of glaucoma.