Purpose: To evaluate the ability of OCT optic nerve head (ONH) and macular parameters to detect disease progression in eyes with advanced structural glaucomatous damage of the circumpapillary retinal nerve fiber layer (cRNFL).

Design: Longitudinal study. Participants: Forty-four eyes from 37 patients with advanced average cRNFL damage (≤60 μm) followed up for an average of 4.0 years.

Methods: All patients were examined with spectral-domain OCT and visual field (VF) assessment during at least 4 visits. Main outcome measurements: Visual field mean deviation (MD) and VF index. OCT cRNFL (average, superior, and inferior quadrants), ganglion cell-inner plexiform layer (GCIPL) (average, superior, and inferior), rim area, cup volume, average cup-to-disc (C:D) ratio, and vertical C:D ratio.

Results: At baseline, patients had a median VF MD of -10.18 dB and mean cRNFL of 54.55±3.42 μm. The rate of change for MD and VF index were significant. No significant rate of change was noted for cRNFL, whereas significant (P < 0.001) rates were detected for GCIPL (-0.57±0.05 μm/year) and ONH parameters such as rim area (-0.010±0.001 mm2/year).

Conclusions: Macula GCIPL and ONH parameters may be useful in tracking progression in patients with advanced glaucoma.