‘Structure–function relationship’ in glaucoma: past thinking and current concepts

Authors

  • Rizwan Malik MRCOphth, PhD,

    1. NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK;
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  • William H Swanson PhD, FAAO,

    1. Indiana University School of Optometry, Bloomington, Indiana, USA
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  • David F Garway-Heath MD, FRCOphth

    Corresponding author
    1. NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK;
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  • Competing/conflicts of interest: DF Garway-Heath: Heidelberg Engineering (research support, speakers' fees); Carl Zeiss Meditec: (research support, consultant, speakers' fees); OptoVue (research support, speakers' fees); Moorfields MDT (co-inventor).

  • Funding sources: Some of the authors (Dr R Malik, Professor DF Garway-Heath) received funding from the National Institute for Health Research (UK) Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology. Professor Garway-Heath's chair at UCL is supported by funding from the International Glaucoma Association. Professor Swanson receives funding from the USPHS National Institutes for Health (EY007716).

Professor David F Garway-Heath, IGA Professor of Ophthalmology, Glaucoma Research Unit, NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, City Road, London EC1V 2PD, UK. Email: david.garway-heath@moorfields.nhs.uk

Abstract

An understanding of the relationship between functional and structural measures in primary open-angle glaucoma is necessary for both grading the severity of disease and for understanding the natural history of the condition. This article outlines the current evidence for the nature of this relationship and highlights the current mathematical models linking structure and function. Large clinical trials demonstrate that both structural and functional change are apparent in advanced stages of disease, and at an individual level, detectable structural abnormality may precede functional abnormality in some patients, whereas the converse is true in other patients. Although the exact nature of the ‘structure–function’ relationship in primary open-angle glaucoma is still the topic of scientific debate and the subject of continuing research, this article aims to provide the clinician with an understanding of the past concepts and contemporary thinking in relation to the structure–function relationship in primary open-angle glaucoma.

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