Comparison of detectability of visual field abnormality by frequency doubling technology in primary open-angle glaucoma and normal-tension glaucoma

PURPOSE: To compare the effectiveness of frequency doubling technology(FDT) in detecting abnormalities in primary open-angle glaucoma(POAG) and normal-tension glaucoma(NTG). SUBJECTS AND METHODS: Twenty-nine POAG patients (29 eyes) and 27 NTG-patients(27 eyes) were studied. All subjects underwent testing with program C-20 of FDT with appropriate corrective lenses. RESULTS: No significant differences were observed between the two groups in mean age, mean deviation(MD), and pattern standard deviation(PSD) measured by the Humphrey Field Analyzer(HFA). The correlation between MD values determined by HFA(x) and FDT(y) is represented by y = 0.60x - 2.7 (r = 0.78, p < 0.01) in the POAG group and y = 0.59x + 0.6 (r = 0.81, p < 0.001) in the NTG group. No significant difference was found in the average PSD between the two groups. In early glaucoma cases (MD > or = -5 dB by HFA), a larger proportion of cases in the POAG group than the NTG group had a lower significance level of MD determined by FDT than by HFA (p < 0.02). At many test points on the temporal periphery in FDT the mean sensitivity was lower in the POAG group than in the NTG group; whereas no significant differences among HFA test points were observed. CONCLUSIONS: FDT detected visual field abnormalities in POAG cases more sensitively than in NTG cases. This finding indicates that the pathogenesis of My-cell damage is different in POAG and NTG.     

Frequency doubling technology perimetry in open-angle glaucoma eyes with hemifield visual field damage: comparison of high-tension and normal-tension groups

PURPOSE: To evaluate the performance of frequency doubling technology (FDT) perimetry in open-angle glaucoma eyes with hemifield visual field damage and to compare it between open-angle glaucoma with high pressure [high-tension glaucoma (HTG)] and those with normal pressure [normal-tension glaucoma (NTG)] groups. METHODS: FDT perimetry with the N-30 full threshold protocol and standard automated perimetry (SAP) using the Humphrey Field Analyzer with the 30-2 full threshold protocol were performed in 20 eyes of 20 HTG patients and 36 eyes of 36 NTG patients with visual field damage confirmed with SAP in only one hemifield. RESULTS: There was no significant difference in demographics, the Heidelberg Retina Tomography indices, and the Humphrey Field Analyzer indices between HTG and NTG groups. Regarding the FDT perimetry results, mean deviation in the global field (P=0.009) and mean sensitivity in the SAP-spared (P=0.001) and SAP-impaired (P=0.011) hemifields were lower; the numbers of FDT abnormal test points (probability of abnormality <5%) in the SAP-spared hemifield were significantly greater (P=0.005) in HTG than in NTG groups. Eyes in which FDT results of the SAP-spared hemifield were judged as abnormal was more frequent in HTG groups (P=0.007). CONCLUSIONS: The performance of FDT perimetry to detect early or preperimetric glaucomatous functional changes should be different between HTG and NTG eyes.     

Relationship between parapapillary atrophy and visual field abnormality in primary open-angle glaucoma

PURPOSE: To investigate the relationship of parapapillary atrophy measured by confocal scanning laser ophthalmoscopy to visual field sensitivity measured with standard automated perimetry and short-wavelength automated perimetry in patients with primary open-angle glaucoma. METHODS: Forty-seven eyes of 47 primary open-angle glaucoma patients with increased intraocular pressure (> or = 22 mm Hg) were enrolled. Optic nerve head topography and parapapillary atrophy (beta and alpha zones) were assessed by confocal scanning laser ophthalmoscopy. Mean deviation and corrected pattern SD were assessed with standard automated perimetry and short-wavelength automated perimetry. RESULTS: Beta and alpha zones were found in 23 (49%) and 47 (100%) eyes with primary open-angle glaucoma, respectively. The area of beta zone showed significant correlations with MD of standard automated perimetry, corrected pattern SD of standard automated perimetry, and corrected pattern SD of short-wavelength automated perimetry (Spearman r = -0.366, P = .012; r = 0.327, P = .025; and r = 0.436, P = .002, respectively). The area of alpha zone showed a significant correlation with mean deviation of standard automated perimetry (r = -0.378, P = .009). Mean MD of standard automated perimetry, mean corrected pattern SD of standard automated perimetry, and mean corrected pattern SD of short-wavelength automated perimetry were significantly worse in eyes with beta zone than in eyes without beta zone. CONCLUSIONS: Parapapillary atrophy measured by confocal scanning laser ophthalmoscopy, especially beta zone, is associated with glaucomatous visual field loss demonstrated by standard automated perimetry and short-wavelength automated perimetry.     

Comparison of visual field defects between normal-tension and primary open-angle glaucoma in the late stage of the disease

Background: There is a lack of studies focusing on differences in visual field damage between normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG) in the late stage of the disease. This problem was addressed in 34 NTG cases and 63 POAG cases with a mean deviation (STATPAC) -15 dB. Age, refraction, mean deviation, best corrected visual acuity and sex ratio showed no significant between-group differences. Methods: Total deviation (STATPAC), the difference between the measured threshold and the age-corrected normal reference at each test point of the Humphrey 30-2 or 10-2 program (TD₃₀ or TD₁₀) was used for pointwise between-group comparisons: (1) difference in the TD₃₀ or TD₁₀ at the examination point due to the difference of disease type was examined using logistic discriminant analysis; (2) a relatively spared point in a given visual field was defined as a test point of TD₃₀ or TD₁₀>mean deviation/3 and the incidence was compared pointwise between the two groups. Further, (TD₃₀-mean TD₃₀) or (TD₁₀-mean TD₃₀) was used to compare the diffuseness of the visual field damage. Results and conclusion: The two methods of pointwise betweengroup comparison gave similar results. In late-stage disease, the inferior ceco-central field was found to be significantly less depressed in NTG than in POAG. Between-group difference was also suggested in the damage in the superior field and the lower Bjerrum area and in the diffuseness of the visual field damage.     

Comparison between visual field defect in pigmentary glaucoma and primary open-angle glaucoma

To compare visual field defect patterns between pigmentary glaucoma and primary open-angle glaucoma. Retrospective, comparative study. Patients with diagnosis of primary open-angle glaucoma (POAG) and pigmentary glaucoma (PG) in mild to moderate stages were enrolled in this study. Each of the 52 point locations in total and pattern deviation plot (excluding 2 points adjacent to blind spot) of 24-2 Humphrey visual field as well as six predetermined sectors were compared using SPSS software version 20. Comparisons between 2 groups were performed with the Student t test for continuous variables and the Chi-square test for categorical variables. Thirty-eight eyes of 24 patients with a mean age of 66.26 ± 11 years (range 48–81 years) in the POAG group and 36 eyes of 22 patients with a mean age of 50.52 ± 11 years (range 36–69 years) in the PG group were studied. (P = 0.00). More deviation was detected in points 1, 3, 4, and 32 in total deviation (P = 0.03, P = 0.015, P = 0.018, P = 0.023) and in points 3, 4, and 32 in pattern deviation (P = 0.015, P = 0.049, P = 0.030) in the POAG group, which are the temporal parts of the field. It seems that the temporal area of the visual field in primary open-angle glaucoma is more susceptible to damage in comparison with pigmentary glaucoma.     

正常眼压型青光眼与高眼压型原发性开角型青光眼是否为同一类型疾病

基于临床考虑,在《我国原发性青光眼诊断和治疗专家共识》中,将正常眼压型青光眼与高眼压型原发性开角型青光眼同归类为原发性开角型青光眼,归属于一类疾病的两个亚型,分界点在于眼压是在正常范围还是高于21 mm Hg(1 mm Hg=0.133 kPa)。但是正常眼压型青光眼与高眼压型原发性开角型青光眼是否应属同一类型疾病,眼...     

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.     

Bradykinin sensitivity in primary open-angle glaucoma and normal-tension glaucoma patients

PURPOSE: To report the reaction after intradermal injection of bradykinin in nonglaucoma, primary open-angle glaucoma, and normal-tension glaucoma subjects. DESIGN: Prospective comparative study. METHODS: The study participants were 14 healthy control subjects, 16 patients with primary open-angle glaucoma, and 15 patients with normal-tension glaucoma. In each participant, the wheal response to intradermal injection of 10 microg bradykinin in the volar forearm was measured by a masked observer. RESULTS: There was no significant difference in the wheal response to bradykinin between control subjects and primary open-angle glaucoma patients (P =.73) and between primary open-angle glaucoma patients and normal-tension glaucoma patients (P =.09). However, there was a significant difference in the wheal response to bradykinin between control subjects and normal-tension glaucoma patients (P =.04). CONCLUSIONS: These in vivo structure-activity studies may suggest abnormalities of the tissue kallikrein-kinin system in normal-tension glaucoma.     

早期原发性开角型青光眼倍频视野的改变

目的　探讨早期原发性开角型青光眼(POAG)倍频视野(FDP)的表现。 方法　应用FDP的N 30全阈值程序和HFA视野计(HFA)中心 30 2全阈值程序检查早期青光眼患者 35例 37眼、进展期青光眼患者 36例 43眼、晚期青光眼患者 6例 7眼;正常人 21例 25眼作为对照组。 结果　早期青光眼的FDP主要表现为相对性旁中心暗点和 /或相对性的弓状暗点,上方弓形区(尤其是 10°~20°的视野)和鼻侧视野在青光眼早期最易受到损害。FDP显示的视野损害与HFA的基本一致,但暗点的范围更大,部分早期青光眼病例HFA显示视野正常的部位FDP也可发现局限性暗点。早期青光眼FDP的三个视野指数(FMS、FMD、FPSD)与正常人比较差异有显著性意义,FDP的FMD与HFA的MD有较好的相关性(相关系数r=0 326,P=0 026)。 结论　早期青光眼FDP的改变与HFA有较高的一致性,在POAG早期诊断中FDP可作为一种快速敏感的视功能检测方法。     

The ability of frequency doubling technology to detect abnormality of visual function in early glaucoma

PURPOSE: To evaluate the ability of the Frequency Doubling Technology(FDT) threshold test in detecting abnormality of visual function in early glaucoma patients. SUBJECTS AND METHOD: The C-20 full threshold test of FDT was performed on 34 normal-tension glaucoma(NTG) patients and 39 primary open-angle glaucoma(POAG) patients with visual field defects limited to the upper or lower hemi-field as detected by Humphrey Field Analyzer(HFA) and on 79 normal control subjects. Optic disk findings and FDT results corresponding to the intact hemi-field were evaluated. FDT abnormalities in normal subjects were calculated as false positive rates in FDT. RESULT: The sensitivity and specificity of FDT, calculated based on optic disk findings, were 75.0% and 61.1% in POAG, and 61.1% and 66.7% in NTG, respectively, while the false positive rate in normal subjects was 11.4%. CONCLUSION: FDT can detect glaucomatous functional abnormality earlier than HFA.     

Long-term effects of isopropyl unoprostone monotherapy on intraocular pressure and visual field for normal-tension glaucoma and primary open-angle glaucoma patients

We retrospectively investigated the long-term effects of isopropyl unoprostone monotherapy on intraocular pressure and visual field for normal-tension glaucoma and primary open-angle glaucoma patients. Among 80 eyes of 49 subjects receiving isopropyl unoprostone monotherapy for 2 years or more, 32 eyes of 32 subjects were analyzed because of the good reliability of their visual acuity and visual field (age, 68.1 +/- 10.1 yrs, follow-up period 47.8 +/- 14.7 months). The mean values of intraocular pressure and visual field indices were compared with baseline data before medication. The visual field changes were also analyzed using the Kaplan-Meier life-table method. The mean intraocular pressure decreased for 4 years from 14.7 +/- 4.3 mmHg (mean +/- SD) at baseline, to 12.7 +/- 4.4mmHg at 4 years. The global index of visual field (mean defect, loss variance) did not change significantly during the 4 years. The accumulative probability of survival was 80.7 +/- 8.0% after 4 years when the endpoint was defined as 3dB progression in mean defect. Isopropyl unoprostone might have the possibility of stabilizing the visual field for a long period of time.     

Rate of visual field progression in primary open-angle glaucoma and primary angle-closure glaucoma

To estimate the rate of visual field progression in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG), we reviewed the medical records of POAG and PACG patients who had a minimum of 5-year longitudinal Goldmann visual field data. I4e and I2e isopters were quantified using grid systems. The rate of change was calculated from the slope of a linear fit to a series of average visual field scores. Twenty-three eyes of POAG patients and 25 of PACG patients were studied. The rate of visual field score change was -2.00 +/- 2.0% per year in the PACG group, and -0.81 +/- 1.0% per year in the POAG group. In these two patient groups, who were on conventional treatment at two referral hospitals, better visual field on initial presentation yielded faster progression in the POAG group, while the higher average of highest intraocular pressure in each year during follow-up was related to faster progression in the PACG group.     

Comparison of frequency doubling perimetry with humphrey visual field analysis in a glaucoma practice

PURPOSE:To determine the sensitivity and specificity of frequency doubling perimetry with Humphrey visual field testing used as the gold standard.METHODS:Frequency doubling perimetry and Humphrey visual field testing (24-2) were performed on 29 consecutive patients in a glaucoma practice. Data for the right eye were used to calculate sensitivity, specificity, and receiver operating characteristic curves.RESULTS:For the frequency doubling perimetry in screening mode, and with an abnormal glaucoma hemifield test used as the gold standard, the area under the receiver operating characteristic curve was 89.3%, 81.5%, or 75.0% for the presence of mild, moderate, or severe relative defects, respectively. Similar results were found with the use of mean deviation (P <.05) to define Humphrey visual field defects. For frequency doubling perimetry in threshold mode, the area under the receiver operating characteristic curve was 93.4% with the presence of any defect (P <.05) used as the criterion for an abnormal case, and an abnormal glaucoma hemifield test as the gold standard. In all cases, the threshold mode detected defects better than the screening mode.     

Systemic high-sensitivity C-reactive protein levels in normal-tension glaucoma and primary open-angle glaucoma

PURPOSE: To determine the systemic high-sensitivity C-reactive protein (hsCRP) level in patients with normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG). MATERIALS AND METHODS: With the exclusion of patients with cardiovascular and other systemic diseases, 40 patients with NTG, 40 with POAG, and 40 normal controls were enrolled in this study. Each patient underwent blood sampling for hsCRP, biochemistry, and lipid profile analysis. RESULTS: Each group had similar demographic parameters including the age, sex, body mass index, heart rate, and blood pressure. There was no statistically significant difference in the hsCRP and biochemistry results between the 3 groups. The lipid profile exhibited a mild elevation in the patients with POAG. CONCLUSIONS: Our data revealed no difference in the hsCRP level between NTG, POAG, and normal controls after exclusion of patients with cardiovascular and other systemic diseases. Systemic vascular inflammation may not be a major cause in the pathogenesis of glaucoma in those without histories of cardiovascular diseases.     

Episcleral venous pressure in untreated primary open-angle and normal-tension glaucoma

The aim of this prospective study was to investigate episcleral venous pressure (EVP) in different forms of glaucoma in comparison with age-matched controls. EVP was measured by means of a venomanometer in 32 eyes with untreated primary open-angle glaucoma (POAG), 36 eyes with untreated normal-tension glaucoma (NTG) as well as 56 control eyes without ophthalmological disease other than cataract. In addition to ophthalmological standard examination, cardiovascular parameters such as systolic and diastolic blood pressure and heart rate were recorded. In the POAG group, EVP was 12.1 +/-0.5 mm Hg and in the NTG group 11.6 +/- 0.4 mm Hg. This was significantly different from EVP of the controls (9.5 +/- 0.2 mm Hg). The EVP/intraocular pressure (IOP) ratio was significantly different in NTG patients (80.0% +/- 3.2) in comparison with both POAG patients (67.1% +/- 2.8) and controls (69.2% +/- 2.4). The difference between IOP and EVP (IOP - EVP) was 6.2 +/- 0.6 in the POAG, 3.1 +/- 0.45 in the NTG and 4.5 +/- 0.4 in the control group. All these values were significantly different from each other. Regression analysis revealed a significant linear correlation between EVP and IOP in both the NTG and the POAG group. In the control group, however, the correlation was weak. This study is the first to demonstrate differences in EVP between untreated NTG and POAG and an age-matched healthy control group.     

Prevalence of normal-tension glaucoma and primary open-angle glaucoma in patients with collagen diseases

PURPOSE: To investigate the prevalence of normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG) in patients with collagen diseases and determine whether an immunocompromised condition is present in a subset of glaucoma patients. METHODS: Three glaucoma specialists prospectively examined patients with collagen diseases. The diagnostic process included applanation tonometry, slit-lamp examination, gonioscopy, direct ophthalmoscopy, and automated static perimetry. Twenty-four-hour intraocular pressure monitoring was done when necessary. Using the results of a population-based survey conducted in Japan, we calculated an expected number of cases of NTG and POAG, and compared these with the actual number of cases. RESULTS: Of the 153 patients with collagen diseases examined, we found 6 patients with NTG and 2 patients with POAG. Of these 8 patients, 2 with progressive systemic sclerosis (PSS), one with NTG, and the other, POAG, had a history of being on systemic steroidal therapy. The prevalence of NTG and POAG was significantly higher in women patients having collagen diseases as compared with normal women (P = .027). CONCLUSION: Women patients with collagen diseases are highly susceptible to NTG and POAG.     

Retinal mean transit time in patients with primary open-angle glaucoma and normal-tension glaucoma

PURPOSE: To compare the mean transit time (MTT) of retinal circulation in eyes with primary open-angle glaucoma (POAG) and eyes with normal-tension glaucoma (NTG) and examine the possible relationship between MTT and visual field damage, expressed as mean deviation (MD). METHODS: Video fluorescein angiography was performed in 40 patients with POAG or NTG. Dye curves for fluorescein passing through the retinal arteries and veins were used to calculate MTT in each patient with a computer-assisted technique based on an impulse-response analysis (MTT(IR)). RESULTS: We were able to analyse MTT(IR) in all 40 angiograms. Mean (SD) MTT(IR) was 5.0 (1.5) seconds in eyes with POAG and 4.7 (1.4) seconds in eyes with NTG. The difference was not statistically significant. There was a weak but significant correlation between the MD and MTT(IR) (MTT(IR) = 4.12-0.08*MD; r = -0.49, p = 0.0013). CONCLUSIONS: The results demonstrate that loss of neuronal tissue in glaucoma is combined with an effect on the retinal circulation and that the effect is similar in eyes with NTG and eyes with POAG.