Association of retinal vessel caliber to optic disc and cup diameters

PURPOSE: To investigate whether optic disc size is related to retinal venule and arteriole diameters. METHODS: The population of Beaver Dam, Wisconsin, aged 43 to 86 years were invited to participate in a baseline examination from 1988 to 1990. During this examination, photographs, centered on the optic discs, were taken after pupil dilation. Optic discs and cups were measured from stereoscopic photographs, whereas retinal vessel measurements were taken from a single digitized photograph. Central retinal vein and central retinal arterial equivalents were subsequently calculated. Data for 3887 right eyes are included in the analyses. RESULTS: Narrower retinal venules and arterioles were found in the smaller optic discs controlling for optic cup diameter as well as age, systolic and diastolic blood pressure, refraction, and sex. Central retinal artery equivalents ranged from 156.04 +/- 16.82 microm in the smallest optic disc category to 165.93 +/- 15.17 microm in the larger disc category (P < 0.001). Central retinal vein equivalents ranged from 228.93 +/- 21.26 microm in the smallest to 243.18 +/- 22.32 microm in the larger disc categories (P < 0.001). The significant reduction in retinal vessel diameters was only apparent for the smallest optic disc sizes. A reduction in retinal vessel diameters was less consistent and not significant for small optic cup sizes. CONCLUSIONS: Smallest optic discs were associated with smaller central retinal artery and central retinal vein diameters. This anatomic relationship may be useful as an additional associated indicator for nonarteritic anterior ischemic optic neuropathy as well as for retinal vascular events.     

Comparison of visual field defects in normal-tension glaucoma and high-tension glaucoma

In a prospective comparison of visual defects in 23 patients with normal-tension glaucoma and 23 with high-tension glaucoma, the groups were matched for equal involvement of the optic disk. F profiles on the Octopus 201 Perimeter were used to quantify thresholds at 1-degree intervals from fixation to define eccentricity, depth, and slope of the scotoma. The mean eccentricity of scotomas in the normal-tension group was 4.86 degrees from fixation; in the high-tension group it was 2.96 degrees. These differences were statistically significant (P less than .01). No statistically significant differences were found between the slopes of the scotomas or depths of the scotomas in the two groups.     

Differential diagnosis in visual field defects of glaucoma patients

In both cases optic disc neuropathy with perimetry defects and loss of vision is caused by a cerebral tumour. The progression of optic damage was stopped by resection of the tumor in both patients. We recommend the performance of a radiological examination in patients with visual field defects if the intraocular pressure is normal and thus glaucoma may not be the cause of the defects.     

原发性闭角型青光眼视野损害的特点

目的 探讨原发性闭角型青光眼(PACG)与原发性开角型青光眼(POAG)及慢性PACG与急性PACG的视野损害特点.方法 系列病例研究.应用Humphrey Ⅱ型(750)视野分析仪的中心30-2程序进行静态阈值视野检查,采用国际地域性和流行病学眼科学组(ISGEO)的分类系统,选取早期青光眼干预性研究(AGIS)评分在1～11分之间的早中期青光眼患者纳入本研究对象.其中慢性PACG组患者53例,急性PACG组患者42例,POAG组患者42例.根据患者视野检查结果,分析各类青光眼患者的视野损害特点.采用SAS 9.1统计学软件进行数据分析.其中组间视野平均缺损值、模式标准差值、鼻侧视野和全视野AGIS计分比较采用2×3析因设计定量资料的方差分析,上、下半侧视野AGIS计分比较采用具有一个重复测量的三因素设计定量资料的方差分析,各组间中央视野受累率、早期鼻侧视野受累率及视野受累最重象限之间的差异采用X2检验.以P<0.05作为差异有统计学意义.结果 (1)与POAG组比较,慢性PACG组(t=4.24,P=0.0000)和急性PACG组(t=3.28,P=0.0013)患者下半侧视野AGIS分值均较高;慢性PACG组(t=1.35,P=0.1808)和急性PACG组(t=0.55,P=0.5824)患者各组内上、下半侧视野计分比较,差异均无统计学意义;POAG组上半侧视野AGIS计分大于下半侧视野AGIS计分,差异有统计学意义(t=6.52,P=0.0000);慢性PACG组模式标准差值明显高于急性PACG组,差异有统计学意义(P<0.05).(2)组间青光眼患者中央10°视野的受累率差异有统计学意义(X2=10.385,P=0.006),POAG组患者中央视野最易受累,而慢性PACG组患者最不易受累.(3)各组青光眼患者早期鼻侧视野普遍受累(X2=2.518,P=0.641),受累最重象限比较,差异无统计学意义(X2=1.573,P=0.954).结论 PACG与POAG组患者比较,其上、下方半侧视野损害无明显差别;急性PACG组与慢性PACG组患者相比,急性PACG组患者上、下方半侧视野损害更弥散,中心视野受累更明显.(中华眼科杂志,2009,45:14-20)     

Pattern of visual field defects in normal-tension and high-tension glaucoma

There are probably two major types of causative factors in open-angle glaucoma: pressure-dependent and pressure-independent. If clinical features such as the pattern of visual field defects differ between normal-tension and high-tension glaucoma, the differences may provide an insight for discriminating between the pressure-dependent and the pressure-independent damage in open-angle glaucoma. This article gives a brief review of the most recent studies including reports wherein progression or pattern of visual field defects in normal-tension and high-tension glaucoma or primary open-angle glaucoma are addressed. Further deterioration of the visual field in 5 years is expected in about 50% of eyes with normal-tension glaucoma in which intraocular pressure is one of the contributing factors. This figure may be greater than that seen in eyes with primary open-angle glaucoma where intraocular pressure is controlled with surgery in the middle teens. When eyes with normal-tension glaucoma and high-tension glaucoma or primary open-angle glaucoma were matched for extent of overall visual field loss, many studies noted a difference in the pattern of visual field defects between the two groups. Visual field defects in normal-tension glaucoma are relatively more localized and closer to fixation, especially in the nasal superior quadrant and may be more predominant in the lower hemifield. Results of other psychophysical tests also appear to support the above findings.     

The lamina cribrosa and visual field defects in open-angle glaucoma

Two types of lamina cribrosa, one with the classic dot-like openings and the other with striate openings, were seen in 71 pairs of optic disc photographs from patients who had chronic open-angle glaucoma, were suspected to have glaucoma or had normal eyes. Of the 11 eyes with a striate pattern 64% showed glaucomatous visual field defects, whereas of the 60 eyes with a dot pattern only 12% showed such defects, a highly significant difference (p less than 0.001); when patient age and ratio of the vertical diameters of the optic cup and disc were controlled the difference remained significant (p = 0.0402). The striate pattern was also significantly associated (p less than 0.05) with a large optic cup (vertical cup/disc ratio 0.7 or greater).     

正常眼压性青光眼黄斑区视网膜厚度和血管密度变化及其与视野的相关性分析

目的　使用光学相干断层扫描血管成像（optical coherence tomography angiography,OCTA）观察正常眼压性青光眼（normal tension glaucoma,NTG）黄斑区视网膜厚度（macular retinal thickness,MRT）和黄斑区血管密度（macular vessel density,MVD）改变,并探讨其与视野平均缺损的相关性。方法　选取NTG 患者20例(40眼)为NTG组,健康20人(40眼)为对照组。利用OCTA检测2组MRT和MVD,对比NTG组与对照组间的差异性,并检验NTG组黄斑区检测指标与视野平均缺损的相关性。结果　NTG组与对照组受检者MRT、MVD在黄斑区中心凹、旁中心凹、上方及下方比较,差异均有统计学意义（F_中心凹MRT＝26.923、F_{旁中心凹MRT}＝38.176、F_上方MRT＝22.324、F_下方MRT＝39.936、F_中心凹MVD＝36.154、F_{旁中心凹MVD}＝45.573、F_上方MVD＝29.345、F_下方MVD＝30.267;均为P＜0.01）,而在颞侧和鼻侧两个象限MRT、MVD差异均无统计学意义（F_颞侧MRT＝2.614、F_鼻侧MRT＝2.497、F_颞侧MVD＝2.134、F_鼻侧MVD＝1.937;均为P＞0.05）;NTG组的黄斑中心凹、旁中心凹、上方及下方的MRT、MVD与视野平均缺损均具有相关性(均为P<0.01）。结论　利用OCTA技术可以有效地反映NTG黄斑区形态学改变特征,且这种改变与视野平均缺损相关,从而可在疾病的早期提供无创影像学诊断支持,为尽早干预治疗提供帮助。     

The mode of progression of visual field defects in glaucoma

We retrospectively studied 42 eyes of 42 patients with glaucoma to determine the pattern of progression of their visual field defects. In 33 eyes (79%) the scotomas became denser. Enlargement occurred in 22 eyes (52%) and 21 eyes (50%) developed new scotomas. Increased density of the scotomas was the only manifestation of change in ten eyes (24%), three eyes (7%) showed enlargement only, and six (14%) showed only new scotomas. Seventeen eyes (57%) with single hemifield involvement maintained a defective single hemifield throughout the follow-up period.     

Twenty-year follow-up of visual field defects in primary glaucoma eyes

PURPOSE: The time course of visual field defects in patients with primary glaucoma was investigated for 20 or more years. METHODS: The subjects were 51 eyes of 29 patients (open angle glaucoma, 40 eyes of 21 patients angle closure glaucoma, 11 eyes of 8 patients). The mean intraocular pressure of these subjects was within 21 mmHg during the follow-up periods. All the eyes were monitored with Goldmann's perimetry, and the visual field was graded using Kozaki's classification. RESULTS: At the 20-year follow-up, 68% of the open angle cases and 45% of the angle closure cases had significant progression of visual field defects. There was no significant difference in average intraocular pressure during the follow-up period between the progression group and the stable group. CONCLUSION: These results suggested that, in a follow-up of twenty years, visual field defects both in primary open angle glaucoma and chronic angle closure glaucoma can progress frequently, even if the intraocular pressure of these patients was well controlled.     

Interocular asymmetry of visual field defects in primary open angle glaucoma and primary angle-closure glaucoma

AIM: To compare the interocular asymmetry in visual field loss of patients with primary open-angle (POAG) and primary angle-closure glaucoma (PACG). METHODS: Subjects entering a prospective, randomised, controlled trial of intraoperative 5-fluorouracil in glaucoma surgery in Singapore were included. Preoperative visual field testing was performed using automated white-on-white perimetry (24-2 test pattern, threshold program, Mk II, Model 750, Zeiss-Humphrey, San Leandro, CA, USA). A minimum of two tests were required with mean deviation within 2 dB on two tests, fixation losses <20%, false positives <33%, and false negatives <33%. The second field was scored using AGIS II criteria and the 'mean asymmetry score' defined as the mean difference between eyes for both AGIS scores and global indices. RESULTS: In 230 subjects assessed (128 POAG, 102 PACG), mean interocular asymmetry of visual field loss was greater for the PACG group. The mean AGIS asymmetry scores for total (PACG=9.21+/-6.87 vs POAG=6.48+/-5.58, P=0.001), superior (PACG=4.31+/-3.39 vs POAG=3.35+/-3.13, P=0.035), and inferior (PACG=4.43+/-3.31 vs POAG=2.64+/-2.77, P<0.0001) areas and mean deviation (MD) asymmetry scores (PACG=6.89+/-13.22 vs POAG=1.66+/-16.97, P=0.012) were all significantly different. Interocular correlation of visual field loss for POAG was significant; total AGIS, r=0.27 (P=0.003), superior field AGIS, r=0.24 (P=0.008), inferior field AGIS, r=0.34 (P=0.0001), and MD, r=0.27 (P=0.003). In PACG, there was no significant correlation between eyes; total AGIS, r=-0.02 (P=0.85), superior field AGIS, r=-0.02 (P=0.82), inferior field AGIS, r=-0.17 (P=0.87), and MD, r=0.015 (P=0.89). CONCLUSION: There was a greater asymmetry of visual field loss between eyes, as measured by AGIS scores and MD, in PACG than that in POAG.     

多导VEPs对青光眼视野损害的诊断价值

目的分折多导VEPs对青光眼半侧视野损害的诊断价值.方法记录115名不同程度的视野损害青光眼患者的全野、半野多导VEPs,分析全野刺激下Oz位,半野刺激下T5/6位P1波的峰潜时延迟出现百分率,分析各位点的波形对青光眼视野损害的诊断率.结果全野、半野刺激下的多导VEPs及其不同位点的综合波形分析能提高多导VEPs对青光眼视野损害的诊断价值.结论全野、半野刺激下的多导VEPs能提高VEP对青光眼半侧视野损害的诊断价值.     

青光眼视野损害的评价方法

青光眼是眼科常见的不可逆性致盲眼病,其主要损害是视网膜神经节细胞（RGCs）及其轴突的变性和丢失,最终可导致视野损害和视力下降。视野检查是青光眼早期诊断以及随访过程中观察病情进展最重要的视功能检查方法,但由于视野检查存在较强的主观性,因此如何建立客观、规范的视野评价和分析方法一直受到青光眼学者们的关注。就目前临床及研究中常用的视野缺损分级方法,包括视野指数、青光眼半视野检测（GHT）、晚期青光眼干预研究（AGIS）评分法、早期青光眼试验（EMGT）评分法、多中心青光眼初始治疗研究（CIGTS）评分法等,及其优缺点进行综述,希望能够对临床及科学研究中视野评价方法的选择有所帮助。     

Diabetes in primary open-angle glaucoma patients with inferior visual field defects

We reviewed the charts of 144 randomly selected patients with primary open-angle glaucoma who had Aulhorn's stage 1, 2, or 3 visual field defects to investigate whether primary open-angle glaucoma patients with predominantly inferior visual field defects had a higher prevalence of diabetes mellitus than primary open-angle glaucoma patients without such visual field defects. Of the 59 patients with mainly inferior visual field defects in one or both eyes, 19 (32%) had diabetes mellitus, while 11 of 85 (13%) patients without such defects had diabetes mellitus. This difference was statistically significant (P=0.0096). These results suggest that primary open-angle glaucoma patients with predominantly inferior visual field defects in one or both eyes are more likely to have diabetes and that such patients with no known history of diabetes may benefit from glucose tolerance testing to detect occult impaired glucose tolerance or diabetes mellitus.Presented as a poster at the American Academy of Ophthalmology Annual Meeting, Atlanta, Georgia, October/November, 1990     

Association of Vistech contrast sensitivity and visual field findings in glaucoma.

Single eye visual fields and contrast sensitivity were assessed in 60 subjects, who were being followed up in a glaucoma clinic for manifest glaucoma or a suspicion of glaucoma because of raised intraocular pressure. The Fieldmaster 5000 (static/kinetic perimeter) was used for the visual fields, and a Vistech wall chart sine wave grating test was used for contrast sensitivity measurements. The subjects were divided into three groups--defect (D), suspect (S) and normal (N)--on the basis of their perimetric findings by subjective grading of 16 perimetric scoring categories for each visual field. The mean Vistech sensitivity levels were not found to be significantly different between the D, S, and N field subgroups at any of the five spatial frequencies provided on the test charts (1.5, 3, 6, 12, and 18 cycles per degree). Complex algorithms combining results from two or more spatial frequencies also failed to yield any significant differences between the groups. Diagnostic sensitivity and specificities relating Vistech contrast sensitivity findings to groups N and D never concomitantly exceeded 60%.