Association between Optic Nerve Head Prelaminar Schisis and Visual Field Progression in Glaucoma: VF progression and Schisis

Ghazaleh Soltani; Takashi Nishida; Sasan Moghimi; Elaine Tran; Maya Yamane; Christopher Girkin; Linda M Zangwill; Robert N Weinreb

doi:10.1016/j.ajo.2025.06.024

Association between Optic Nerve Head Prelaminar Schisis and Visual Field Progression in Glaucoma: VF progression and Schisis

Am J Ophthalmol. 2025 Jun 20:S0002-9394(25)00312-5. doi: 10.1016/j.ajo.2025.06.024. Online ahead of print.

Authors

Ghazaleh Soltani¹, Takashi Nishida¹, Sasan Moghimi¹, Elaine Tran¹, Maya Yamane¹, Christopher Girkin¹, Linda M Zangwill¹, Robert N Weinreb²

Affiliations

¹ Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States.
² Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States. Electronic address: rweinreb@ucsd.edu.

PMID: 40545018
DOI: 10.1016/j.ajo.2025.06.024

Abstract

Purpose: To investigate the association between baseline optic nerve head (ONH) prelaminar schisis and the rates of visual field mean deviation (VF MD) slopes in glaucoma.

Design: Retrospective clinical cohort study.

Methods: This study included 563 eyes (446 with primary open-angle glaucoma [POAG] and 117 glaucoma suspect eyes) from 332 patients. Two independent graders evaluated the baseline presence and severity of prelaminar schisis using optical coherence tomography (OCT) radial scans. The severity was graded on a four-point ordinal scale: 0 (none), 1 (mild), 2 (moderate), and 3 (severe). The inter-rater reliability was assessed using weighted kappa. Two linear mixed-effect models were employed to assess the association between the presence of schisis (model 1) and schisis severity (model 2) with VF MD slopes, while adjusting for relevant demographic and ocular characteristics.

Results: Prelaminar ONH schisis was observed in 258 eyes (45.8%). Among these, grade 1 was identified in 36 eyes (14.0%), grade 2 in 181 eyes (70.2%), and grade 3 in 41 eyes (15.9%). The weighted kappa was 0.66. In multivariable models, the presence of schisis was associated with a faster VF MD slope (-0.22 dB/year; 95% CI: -0.30, -0.13 p≤0.001). Compared to eyes without prelaminar schisis (Grade 0), those with schisis were associated with faster VF MD slopes. This was more significant with Grade 3 (-0.40 dB/year; 95% CI: -0.63, -0.18; P<0.001) than with grade 1 (-0.18 dB/year; 95% CI: -0.34, -0.03; P=0.023), or grade 2 (-0.18 dB/year; 95% CI: -0.26, -0.09; P<0.001). Age and baseline VF MD were also independently associated with VF progression in both models.

Conclusion: The presence and severity of severe prelaminar schisis were associated with faster VF progression, suggesting its potential as a biomarker to identify patients at higher risk of progression and to guide clinical management in glaucoma.

Keywords: VF progression; glaucoma; optic nerve head; prelaminar schisis.