Clinical Publications

TRITON

Risk Stratification Using OCT-based Score in Glaucoma Suspects

AUTHORS:

Manivannan N; Hou H; Nishida T; Walker E; Durbin MK; Zangwill LM; Weinreb RN; Moghimi S

PUBLICATION:

ARVO 2026 Abstract / Conference Presentation

Study Purpose

To develop and evaluate an OCT-based risk stratification approach using composite Fukai-Nakano scores to predict perimetric conversion in glaucoma suspects and support more informed clinical management.

Overview

Study Design

Prospective longitudinal cohort study of glaucoma suspects enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS) with normal baseline visual fields and semiannual follow-up.

# of Eyes/
Patients

251 eyes from 179 patients (mean follow-up: 2.9 years)

Study Device

Swept-source OCT (Triton, Topcon Corporation, Tokyo, Japan)

Outcome Measures

Primary outcome was visual field conversion to glaucoma. Secondary analyses included conversion rates by risk tertiles, odds ratios per tertile increase, diagnostic performance (sensitivity/specificity), and discriminative ability (AUROC) compared with conventional OCT parameters.

Results

During a mean follow-up of 2.9 years, 79 eyes developed visual field-defined glaucoma. Fukai-Nakano composite scores demonstrated clear stratification of conversion risk, with the highest-risk tertile showing substantially greater progression rates (>50%). All three models showed similar performance, with AUROC values of 0.71-0.72, exceeding those of individual OCT parameters including cpRNFL (0.68), VCDR (0.65), and GCIPL (0.64). Using the highest tertile as a high-risk cutoff yielded a sensitivity of 0.53-0.56 and specificity of 0.76-0.77.

IMOvifa reduced measurement time by

39%

Conclusions

Composite OCT-based Fukai-Nakano scores enable effective risk stratification of glaucoma suspects and provide improved discrimination compared with single structural parameters. This approach may support clinical decision-making by facilitating earlier identification of high-risk patients and optimizing referral and monitoring strategies.