Corneal stiffness parameters are predictive of structural and functional progression in glaucoma suspect eyes

Ayub Qassim*, Sean Mullany, Farshad Abedi, Henry Marshall, Mark M. Hassall, Antonia Kolovos, Lachlan S. W. Knight, Thi Nguyen, Mona S. Awadalla, Angela Chappell, Angela M. Schulz, Anna Galanopoulos, Ashish Agar, Paul R. Healey, Alex W. Hewitt, Stuart L. Graham, John Landers, Robert J. Casson, Owen M. Siggs, Jamie E. Craig

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

35 Citations (Scopus)


Purpose: To investigate corneal stiffness parameters (SPs) as predictors of future progression risk in glaucoma suspect eyes. Design: Prospective, longitudinal study. Participants: Three hundred seventy-one eyes from 228 primary open-angle glaucoma suspects, based on optic disc appearance, with normal baseline Humphrey Visual Field (HVF; Carl Zeiss Meditec) results. Methods: Baseline corneal SPs were measured using Corvis ST (Oculus Optikgeräte GmbH). Participants were followed up every 6 months with clinical examination, HVF testing, and OCT. The baseline SP at first applanation (SP-A1) and highest concavity predicted the prospective outcome measures. Main Outcome Measures: Structural progression was measured by the OCT rate of thinning of the retinal nerve fiber layer (RNFL) and ganglion cell–inner plexiform layer (GCIPL). Functional progression was assessed by permutation analysis of pointwise linear regression criteria on HVF testing. Results: Stiffness parameters correlated positively with central corneal thickness (CCT), which was adjusted for in all analyses. A higher SP-A1, suggestive of a stiffer cornea, was associated with a faster rate of RNFL thinning (P < 0.001), synergistic with thinner CCT (P = 0.004) over a mean follow-up of 4.2 years. Eyes with higher SP-A1 and thinner CCT (thin and stiff corneas) showed accelerated RNFL thinning by 0.72 μm/year relative to eyes with lower SP-A1 and thicker CCT (95% confidence interval [CI], 0.17–1.28; P = 0.011) and were at 2.9-fold higher likelihood of fast RNFL progression of more than 1 μm/year (95% CI, 1.4–6.1; P = 0.006). Consistent results also were observed with GCIPL thinning. Furthermore, a higher SP-A1 was associated with a greater risk of visual field progression (P = 0.002), synergistic with thinner CCT (P = 0.010). Eyes with higher SP-A1 and thinner CCT were at 3.7-fold greater risk of visual field progression relative to eyes with thicker CCT and lower SP-A1 (95% CI, 1.3–10.5; P = 0.014). Conclusions: Glaucoma suspect eyes with higher corneal SPs and lower CCT, suggestive of thin and stiff corneas, are at greater risk of progression. Corneal SPs seem to act synergistically with CCT as risk factors for glaucoma progression.

Original languageEnglish
Pages (from-to)993-1004
Number of pages12
Issue number7
Publication statusPublished - Jul 2021


  • Corneal biomechanics
  • Corvis ST
  • Glaucoma
  • Glaucoma suspect
  • OCT
  • PoPLR
  • Progression
  • Prospective study
  • Risk stratification
  • Stiffness


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