Glaucoma suspects with more corneal stiffness and a thinner central corneal thickness (CCT) have a greater chance of disease progression, a recent study published in Ophthalmology reports. The research team from Australia found that these eyes had more rapid thinning of the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) and were more likely to have progressive visual field (VF) loss.

The study found stiffness parameters correlated positively with CCT. At four years, larger stiffness parameters at the first applanation—suggestive of a stiffer cornea—were tied to a faster rate of RNFL thinning, which was associated with a thinner CCT. Stiffness was also associated with a greater risk of VF progression, which was linked to a thinner CCT.

Of the 371 eyes of 228 primary open-angle glaucoma suspects, stiffer eyes at baseline with a thinner CCT had an accelerated RNFL thinning rate of 0.72μm/year compared with less stiff eyes that had a thicker CCT. These eyes had a three-times higher risk of RNFL progression of more than 1μm/year and a four-times higher risk of VF progression. These results were consistent with GCIPL thinning findings.

These conclusions provide further evidence that supports the importance of corneal biomechanical factors in stratifying the risk of progression in glaucomatous eyes, the investigators noted.

Qassim A, Mullany S, Abedi F, et al. Corneal stiffness parameters are predictive of structural and functional progression in glaucoma suspects. Ophthalmology. November 24, 2020. [Epub ahead of print].