应用海德堡视网膜断层扫描仪检测开角型青光眼的视盘改变

目的探讨海德堡视网膜断层扫描仪(Heidelberg retinal tomography,HRT)检测青光眼性视盘改变是否与视野损害的部位相一致,了解正常眼压性青光眼(normal tension glaucoma,NTG)与原发性开角型青光眼(primary open angle glaucoma,POAG)早或中期视盘形态是否异同.方法对64例(64只眼)仅有半侧视野异常的开角型青光眼(POAG27只眼、NTG37只眼)患者进行HRT检测,将Humphery视野与HRT的检测结果以0°～180°为界,分成上下两部分进行对应分析.结果与正常半侧视野对应的1/2视盘比较,显示异常半侧视野对应的1/2视盘HRT参数中,杯盘面积比、视杯形态测量值显著增大,而盘沿面积、视网膜神经纤维层厚度及视网膜神经纤维层横断面积值显著减少 (t=-2.625～3.025,P=0.003～0.05);NTG眼和POAG眼对应与异常半侧视野的HRT视盘参数差异无显著性(t=-0.98～1.511,P=0.14～0.97).结论 HRT参数能较准确反映与视野损害相一致的视盘变化,其中尤以杯盘面积比、盘沿面积、视杯形态测量、平均视网膜神经纤维厚度及视网膜神经纤维层横断面积测量值较为准确.NTG和POAG眼的视盘形态相似,可能具备某些相似的视神经损害发生机制.     

微视野计对半侧视野损害的青光眼固视稳定性改变的评估价值

背景 研究证实,与传统的视野计相比,微视野计可以发现更微小的青光眼视功能损害,但目前关于青光眼固视功能改变的研究较少. 目的 比较微视野计Maia与Humphrey视野计检测结果的相关性,探讨Maia微视野计对半侧视野损害的青光眼患者固视稳定性改变的评估价值. 方法 采用横断面研究设计,纳入2013年12月至2014年3月于北京大学第一医院应用Humphery视野计24-2程序检测为半侧视野缺损的青光眼患者35例35眼,同期纳入正常对照者30人30眼.分别接受Humphery(10-2)和Maia(expert 10-2)检测,分析青光眼患者Humphrey视野检测与Maia微视野计检测的相关性.然后进一步将Humphrey半侧视野正常者分为Maia正常组和Maia异常组,比较青光眼组与正常对照组、Maia正常组与Maia异常组固视稳定性的差异.结果 Maia与Humphrey视野计检测的平均光敏感度间呈中度正相关(r=0.403,P=0.001),青光眼患者Maia平均阈值与Humphrey视野平均缺损(MD)值呈中度正相关(r=0.438,P=0.008).青光眼组和正常对照组固视稳定性参数P1分别为(67±17)％和(87±10)％,P2分别为(70±16)％和(88±9)％,2个组的63％双曲线椭圆面积(BCEA)分别为(5.08±1.55)°2和(2.21±0.60)°2,95％ BCEA分别为(14.74±6.04)°2和(2.86±1.17)°2,青光眼组的P1和P2值均明显低于正常对照组,而63％ BCEA和95％BCEA值均明显高于正常对照组,差异均有统计学意义(t=-5.604、-4.831、9.885、11.086,均P=0.000).Maia正常组和Maia异常组P1分别为(79±8)％和(63±17)％,P2分别为(81±10)％和(67±l6)％,63％BCEA分别为(3.19±0.65)°2和(5.70±1.22)°2,95％ BCEA分别为(9.10±2.60)°2和(19.35±5.01)o2,Maia 异常组较Maia正常组P1、P2均明显降低,63％ BCEA和95％ BCEA均明显增加,差异均有统计学意义(t=-2.468,P=0.019;t =-2.371,P=0.024;t=5.514,P=0.000;t=5.575,P=0.000). 结论 Maia微视野计与Humphery视野计在检测青光眼黄斑功能方面具有较好的相关性,Maia微视野计可发现半侧视野损害的青光眼患者固视稳定性下降.     

HRT-II在正常眼压性青光眼诊断中的应用

目的　探讨海德堡视网膜断层扫描仪 II(HRT II)在正常眼压性青光眼 (normaltensionglaucoma ,NTG)诊断中的意义。方法　对 2 4例 4 8眼NTG患者进行HRT II检测和自动视野计检查 ,统计分析HRT II检测的敏感性、与视野的对应关系、参数和病变分区特点。结果　 2 4例 4 8眼中视野异常 4 1眼 ,HRT II检测异常 4 1眼 ;视野异常和HRT II异常对应为 91.6 7% ;单眼视野异常组 7例有对侧 2眼视野正常而HRT II检测异常 ,对侧 5眼视野正常而HRT II检测也正常。视盘参数为 :视盘面积 (1.5 6 7± 0 .349)mm2 ,视杯面积为 (1.4 4 7± 0 .2 6 3)mm2 ,盘沿容积为 (0 .16 3± 0 .14 7)mm3 ,盘沿面积为 (0 .6 82± 0 .390 )mm2 ,C/D为 0 .738±0 134,平均视杯深度 (0 .32 7± 0 .12 0 )mm ,平均视网膜纤维厚度为 (0 .193± 0 . 16 1)mm。颞下象限盘沿面积异常占6 9 77% (30 /43) ,颞上为 6 0 .4 7% (2 6 /43) ,鼻下为 76 .74 %(33/43) ,鼻上为 6 0 .4 7% (2 6 /43) ,颞侧为 4 8.84 % (2 1/43) ,鼻侧为 6 0 .4 7% (2 6 /43)。结论　 (1)HRT II检测是NTG诊断的方法之一 ,敏感性良好 ;(2 )HRT II检测和视野改变有良好的对应关系 ,而NTG患者HRT II异常可能早于视野改变 ,可以用于NTG的早期诊断     

倍频视野检测在40岁以上人群中筛查青光眼的价值

目的探讨倍频视野检测(FDP)程序在40岁以上自然人群中筛查青光眼的敏感性和特异性.方法 2001年5至10月对北京市大兴区榆垡乡3个自然村及市区北部4个社区40岁以上居民4439人进行青光眼筛查.所有受试者均用倍频视野计的C-20-1筛查程序检测视野.对可疑青光眼者在非筛查日进行Octopus阈值视野、前房角镜及视乳头立体照相检查.根据Octopus视野检测的平均缺损(MD)值,将筛查出的青光眼分为轻、中、重三级.FDP的分析指标包括FDP检测时间、异常位点数、FDP计分、4个象限FDP计分等.正常人随机选一只眼的数据用于分析;双眼青光眼患者选择视神经或Octopus视野损害较轻的眼用于分析.结果 4330例(97.5%)用于FDP分析.以FDP结果≥1个点异常为临界点,将人群分为正常人与青光眼两组,则FDP检查青光眼的敏感性为50.7%(72/142),特异性为96.6%(2260/2340),受试者工作特征曲线下面积(AUC)为0.7,阳性预测值47.7%,阴性预测值96.9%,阳性似然比14.8,阴性似然比0.5.若除外无青光眼性视神经与Octopus视野损害的青光眼,则FDP检测青光眼的敏感性为76.4%,AUC为0.9, 阳性预测值为40.7%,阴性预测值99.2%,阳性似然比22.3,阴性似然比0.2.检测轻、中、重度青光眼的敏感性分别为54.2%、76.0%、100.0%.FDP视野的4个象限计分与Octopus视野4个相应象限的MS呈显著负相关(Rs分别为-0.732、-0.628、-0.639、-0.679,均P＜0.01).结论 C-20-1 FDP筛查程序适用于在大规模人群中筛查青光眼,具有较高的特异性;对中、重度青光眼性视野缺损患者具有良好的敏感性.     

应用眼底断层扫描检测青光眼视盘改变与视野的一致性研究

目的 探讨眼底断层扫描（Heidelberg Retina Tomograph HRT）检测开角型青光眼患者与正常对照个体视盘参数与其相应视野改变的一致性.方法 对100例正常个体、32例开角型青光眼进行HRT及视野检查,将结果进行对照分析.结果 100例正常对照组视野检查、HRT检查均正常,开角型青光眼患者视野、HRT则出现不同程度改变.对于开角型青光眼在视野缺损一侧HRT检查显示视盘参数改变较视野正常一侧杯盘面积比、缘面积、纤维层厚度等特异性指标改变更加明显.这一结果表明视野出现不对称性改变,盘缘组织亦出现不对称,HRT参数反映出视盘的改变与视野损害的部位一致.结论 应用HRT及视野检查可以早期发现开角型青光眼,且HRT较视野具有更高的重复性、敏感性、特异性,二者同时进行检查,有助于在开角型青光眼尚未出现症状时早期发现和早期治疗.     

Discam彩色数字立体成像仪视乳头参数与青光眼视野损害的相关性研究

目的:研究Discam彩色视乳头数字立体成像仪测量的视乳头参数与开角型青光眼视野损害的相关性,探讨Discam彩色视乳头数字立体成像仪在开角型青光眼诊断中的应用价值。方法:采用Discam彩色视乳头立体成像仪在ScreenVu立体观察镜下确定31例(58眼)开角型青光眼及29例(58眼)可疑青光眼患者垂直杯盘比(verticalcup-discratio,V-CDR),水平杯盘比(horizontalcup-discratio,H-CDR),杯盘面积比(areacup-discratio,A-CDR)及沿盘面积比(arearim-discratio,A-RDR)。采用Humphrey自动电脑视野分析仪(30-2程序)对上述患者进行视野检测,研究上述视乳头参数与视野损害分组及视野指数视野平均缺损值(meandefect,MD)、视野模式标准差值(patternstandarddeviation,PSD)的相关性。结果:对116眼开角型青光眼及可疑青光眼患者研究发现,青光眼组上述视乳头参数与MD(P<0.000)、PSD(P<0.000)显著相关。而可疑青光眼组上述视乳头参数与MD、PSD无显著相关性。正常视野组及异常视野组视乳头参数的均值比较有显著统计学意义。结论:开角型青光眼患者Discam彩色数字立体成像仪视乳头参数与视野损害显著相关,Discam彩色数字立体成像系统可对视乳头进行定量描述并可用于评价开角型青光眼的视乳头损害。     

慢性闭角型青光眼视野损害的特点

目的　为了了解早中期慢性闭角型青光眼 (chronicangleclosureglaucoma ,CACG)的静态视野损害特点。对象与方法　对象为MD≤ 15dB的慢性青光眼患者 81例 81只眼 ,其中CACG 2 7例 2 7只眼 ,正常眼压性青光眼 19例 19只眼 ,和原发性开角型青光眼 3 5例 3 5只眼。采用Octopus10 1视野计G2程序 ,将视野内 5 9个静点划分为 9个区和中央 1个点 ,通过图中各点的值 ,分别计算每只眼的每个点、区的MD ;再将视野以 0°～ 180°为界 ,分成上下两个半侧视野 ,分别计算和比较上方和下方半侧视野的MD和LV ;最后对中央 9个点 (6°范围 )进行受累情况的判断 ,并进行CACG、POAG和NTG三组组内和组间的比较。结果　CACG组的中央区MD比POAG NTG组要小 (Z =-2 0 69,P =0 0 3 9) ,其余各区和中心点差异无显著性 (Z =-0 0 6～ 1 72 1,P =0 0 9～ 0 95 2 ) ;CACG和POAG上方半侧视野的MD明显比下方的MD要大 (P =0 0 2 4和 0 0 10 ) ,而NTG的上下方视野MD差异无显著性 (P =0 0 77)。CACG、NTG和POAG中央 6°视野的受累率分别是 2 5 9%、5 7 9%和 5 1 9% (P =0 0 40 )。结论　CACG上方半侧视野比下方受损明显 ,与POAG/NTG视野改变模式有所不同的是 ,中央视野比较不易受损。     

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。     

蓝/黄视野检查法对原发性开角型青光眼正常半侧视野的检测

目的　探讨蓝/黄视野检查法( blue-on-yellowperimetry,BYP)检测早期青光眼视野异常的能力。方法　对普通白/白视野检查法(white on-white-perimetry,WWP)检查结果仅为半侧视野异常的23例23眼原发性开角型青光眼患者进行BYP检查。结果　BYP检查的平均光敏感度、平均缺损及偏离缺失值与WWP检查的平均光敏感度、平均缺损及偏离缺失分别呈明显正相关(r 分别为0.597 0,0.787 9和0.850 7,P<0.000)。WWP检查异常的半侧视野中,BYP检查的视野缺损点数明显多于WWP检查的缺损点数(t=2.1535,P=0.018 4);WWP检查正常的半侧视野中,有52.17%(12/23)的患者出现BYP检查结果异常。结论　BYP检查法能发现WWP检查法尚不能检出的视野缺损。     

原发性青光眼早期视盘参数与视野缺损的关系

目的 探讨应用海德堡视网膜断层扫描仪(HRT-Ⅱ)检测原发性青光眼患者视盘参数改变及其与Humphrey 750检测视野改变间的关系.方法 49例原发性青光眼患者和30例对照个体分别行Humphrey 750视野与HRT-Ⅱ检查,每例患者的双眼间视盘损害与视野缺损间的对应关系彼此独立,双眼均被纳入研究.比较对照个体、慢性闭角型青光眼(CACG)、开角型青光眼(POAG)和正常眼压性青光眼(NTC)患者视乳头参数的差异,分析视乳头各项参数分别与各自视野指数(MD)间的相关性.将对照个体与原发性青光眼患者的视盘参数进行逐步判别分析,建立判别函数,筛选出诊断青光眼的敏感参数.结果 HRT-Ⅱ和Humphrey 750检测对照组、CACG组、POAC组和NTG组四组间视野平均缺损(1VID)、视杯面积(CA)、视盘面积(DA)、盘沿面积(RA)、视杯容积(CV)、盘沿容积(RV)、杯盘面积比(CDAR)、线性杯盘比(LCDR)、平均视杯深度(MCD)、最大视杯深度(max CD)、视杯形态(CSM)、视杯高度变异轮廓(HVC)、平均视网膜神经纤维层厚度(MRNFLT)、视神经纤维层横截面积(RCSA)等差异具有显著统计学意义(P<0.01).对照组中LCDR和MD呈直线线性相关,POAG组中DA、CA和MD呈直线线性相关,NTG组中CA、RA、CV、CDAR、HVC和MD呈直线线性相关.经逐步回归筛选的变量中,CV和HVC是其中2个有意义的参数,得出回归方程MD=4.475×CV+5.338×HVC-0.480.诊断敏感的视盘参数为RA、RV、MRNFLT、CSM、HVC,判别函数式为D=2.767+0.312×RA +3.731×RV+4.294×MRNFLT-3.668×CSM-4.024×HVC.结论 临床上应用HRT-Ⅱ检测视盘参数与Humphrey750检测视野结果结合对照分析有助于原发性青光眼的早期诊断.     

Frequency doubling technology and confocal scanning ophthalmoscopic optic disc analysis in open-angle glaucoma with hemifield defects

PURPOSE: To evaluate the potential of frequency doubling technology for detecting early glaucomatous damage. PATIENTS AND METHODS: Forty-nine eyes of 49 patients with open-angle glaucoma with visual field defects only in one hemifield according to the Humphrey Field Analyzer 30-2 program were included. Forty-five healthy patients were also included as control subjects. In each patient, frequency doubling technology with the threshold N-30 program and optic disc analysis using the Heidelberg Retina Tomograph was performed. Frequency doubling technology test results and the Humphrey Field Analyzer test results were compared. Optic disc parameters corresponding to the hemifield designated intact by the Humphrey Field Analyzer were compared between the eyes in which the hemifield was normal by frequency doubling technology and those in which the hemifield was abnormal. RESULTS: Forty-one percent of the 49 hemifields designated intact by the Humphrey Field Analyzer were abnormal based on frequency doubling technology, whereas 98% of the 49 hemifields designated defective by the Humphrey Field Analyzer were abnormal and 12% of the 90 hemifields designated intact by the Humphrey Field Analyzer were abnormal in healthy patients. The percentage of the hemifields designated abnormal by frequency doubling technology was significantly higher than that in healthy patients (P < 0.001). The rim volume was significantly smaller in eyes with abnormal results based on frequency doubling technology than in eyes with normal results (P < 0.05, paired t test, with Bonferroni correction for multiple comparison). CONCLUSION: Frequency doubling technology can detect glaucomatous damage earlier than conventional static perimetry can.     

海德堡视网膜断层扫描仪在开角型青光眼视盘检测中的意义

目的 探讨海德堡视网膜断层扫描仪(HRT)检测开角型青光眼视盘参数与视野损害的关系。评价HRT在早期诊断青光眼中的意义。方法 正常人26例(41只眼)，高眼压11例(16只眼)、原发性开角型青光眼28例(38只眼)。采用Humphrey全自动视野计、HRT分别进行视野、视盘形态检测。比较正常组、高眼压组、青光眼组HRT视盘检测参数．分析青光眼组视野检测的平均缺损(MD)与HRT视盘检测参数的关系。结果 正常组、高眼压组、青光眼组视杯面积、杯／盘面积比、盘沿面积、视杯形态测量指数、视网膜神经纤维层厚度差异有显著性。青光眼组的盘沿面积、杯／盘面积比、视杯形成测量指数、视网膜神经纤维层厚度与视野检测的平均缺损有显著相关。结论 HRT能够反映青光眼视盘改变，为临床早期诊断青光眼提供更多的信息。     

HRT视盘参数在原发性开角型青光眼早期诊断中的作用

目的:在众多海德堡视网膜断层扫描仪(heidelberg retina tomogragh,HRT)测定的视盘参数中,筛选出最有助于青光眼早期诊断的视盘参数。方法:用HRT测定23例视野损害较轻的青光眼患者和23例正常人的视盘参数(杯盘面积比、盘沿面积、盘沿容积、视杯容积、视杯形态测量、视杯高度变异轮廓和平均神经纤维层厚度)作逐步判别分析。结果:盘沿面积和杯盘面积比对青光眼早期诊断最有帮助,其诊断敏感度和特异度分别为87%和96%。结论:本组资料盘沿面积和杯盘面积比是区分青光眼和正常眼最好的判别因素。     

Heidelberg retina tomography and optical coherence tomography in normal, ocular-hypertensive, and glaucomatous eyes.

PURPOSE: To evaluate optic disc and retinal nerve fiber layer (RNFL) appearance in normal, ocular-hypertensive, and glaucomatous eyes undergoing confocal scanning laser ophthalmoscopy and optical coherence tomography (OCT). DESIGN: Prospective, cross-sectional study. PARTICIPANTS: Seventy-eight eyes of 78 consecutive normal (n = 17), ocular-hypertensive (n = 23), and glaucomatous subjects (n = 38) were enrolled. METHODS: Each patient underwent complete ophthalmic examination, achromatic automated perimetry, confocal scanning laser ophthalmoscopy (Heidelberg Retinal Tomography [HRT]), and OCT. Topographic HRT parameters (disc area, cup-disc ratio, rim area, rim volume, cup shape measure, mean RNFL thickness, and cross-sectional area) and mean OCT-generated RNFL thickness were evaluated in each group. MAIN OUTCOME MEASURES: OCT and HRT assessment of optic disc and RNFL anatomy. RESULTS: OCT RNFL thickness showed no difference between normal and ocular-hypertensive eyes (P = 0.15) but was significantly less in glaucomatous eyes (P < 0.001). HRT measurements of rim area, cup-disc ratio, cup shape measure, RNFL thickness, and RNFL cross-sectional area were significantly less in glaucomatous eyes (all P < 0.005) and were correlated with mean OCT RNFL thickness (all P < 0.02). RNFL thickness using OCT or HRT was highly correlated with visual field mean defect during achromatic perimetry (P < 0.0001). CONCLUSION: Both HRT and OCT can differentiate glaucomatous from nonglaucomatous eyes. RNFL thickness measurements using OCT correspond to disc topographic parameters using HRT.     

Analysis of retinal nerve fiber layer thickness measured by optical coherence tomography in glaucomatous eyes with hemifield defect

PURPOSE: To analyze the retinal nerve fiber layer thickness(NFLT) as measured by optical coherence tomography(OCT) in glaucomatous eyes with hemifield defect and to evaluate the most effective parameter for the diagnosis of glaucoma with OCT. METHODS: One hundred eighty four(184) normal eyes(128 subjects) and 108 open-angle glaucomatous eyes(87 subjects) with superior or inferior hemifield defects verified by Humphrey field analyzer(HFA) were measured for NFLT with OCT. The correlations between NFLT and mean deviation on HFA were calculated. In combination with normal eye data, receiver operating characteristic curve(ROC curve) and AUC(area under the curve) of each NFLT in the affected hemifield were evaluated for the diagnosis of glaucoma. RESULTS: NFLT in both affected and unaffected hemifields was significantly correlated with mean deviation in HFA. An average of four 30 degrees segments close to the temporal side in the affected hemifield (parameter A120) had the highest correlation(r = 0.571) and the highest AUC(0.948) among all parameters. CONCLUSIONS: NFLT in the unaffected visual field decreases with the progression of glaucomatous damage. We suggest that the parameter A120 is the best indication in a diagnosis of glaucoma when measuring NFLT by OCT.     

国际闭角型青光眼新分类中Humphrey视野及HRT-Ⅱ参数的相关性

目的:分析海德堡视网膜断层扫描仪-II(HRT-II)和Hum-phrey视野计检查平均视野缺损(mean defect,MD)间的相关性及其临床价值。方法:闭角型青光眼患者69例117眼,按照国际闭角型青光眼分类法分为可疑原发性房角关闭(primary angle-clo-sure suspect,PACS)38眼,原发性前房角关闭(Primary an-gle-closure,PAC)53眼和原发性闭角型青光眼(primary angle-closure glaucoma,PACG)26眼,利用HRT-Ⅱ和Hum-phrey视野计检查正常人30例60眼和各类闭角型青光眼患者的视盘形态、视网膜神经纤维层(RNFL)厚度和视野,获得视杯面积、视盘面积、盘沿面积、视杯容积、盘沿容积、杯盘面积比、线性杯盘比、平均视杯深度、最大视杯深度、视杯形态测量、视杯高度变异轮廓、平均视网膜神经纤维层厚度、视神经纤维层横截面积和MD等参数,对比分析正常人和各类闭角型青光眼患者之间的各参数的差异。并将各类闭角型青光眼的HRT-Ⅱ的各参数与MD进行相关性分析。结果:HRT-Ⅱ和Humphrey视野计检测对照组与PACS、PAC和PACG4组间各视盘参数和MD差异具有统计学意义(P<0.01)。对照组中LCD和MD呈直线相关,PACS组中DA、CA和MD呈直线相关,PAC中CA,RA,CV,CDAR,HVC和MD呈直线相关。经逐步回归筛选的变量中,CV和HVC是其中2个有意义的参数,PAC组中CV和HVC与MD之间的Pearson相关系数为0.290和0.301,得出CV和HVC与MD之间回归方程:Y=4.475X1+5.338X2-0.480(Y表示MD,X1表示CV,X2表示HVC)。结论:HRT-II和Humphrey视野检查参数在新的闭角型青光眼分类具有一定的临床价值,MD与CV和HVC相互参照分析有助于判断闭角型青光眼的发展。     

Nerve fiber layer thickness in glaucoma patients with asymmetric hemifield visual field loss

PURPOSE: To investigate the presence of retinal nerve fiber layer (RNFL) thinning and determine the relationship between RNFL thickness and visual field sensitivity loss in glaucoma patients with asymmetric hemifield visual field loss. PATIENTS AND METHODS: Thirty glaucoma patients with asymmetric hemifield visual field loss and 30 normal control subjects were included in the study. RNFL thickness was measured by optical coherence tomography and visual field sensitivity was measured by automated perimetry. Glaucoma patients with advanced visual field loss restricted to 1 hemifield and early or absent glaucomatous field loss in the other hemifield on the basis of the visual field data were included. Visual field sensitivity and mean deviation (MD) were averaged separately in each of the 2 hemifields. The hemifields in each eye were categorized as early (MD>or=-6 dB) and advanced (MD<-6 dB) glaucomatous hemifields. RESULTS: RNFL thickness measurements in corresponding (eg, superior peripapillary quadrant with inferior hemifield) advanced glaucomatous hemifields (59+/-16 microm) were significantly (P<0.001) lower than in corresponding early glaucomatous hemifields (90+/-25 microm). The mean RNFL thickness in corresponding advanced and early glaucomatous hemifields were significantly lower than in normal control subjects (P<0.0001). On the basis of the normative database supplied by optical coherence tomography software, 100% and 43% of eyes had abnormal RNFL thickness in corresponding advanced and early glaucomatous hemifields, respectively. A linear correlation was found between RNFL thickness and MD in the early (r=0.6; P<0.001) and advanced (r=0.5; P=0.007) glaucomatous hemifields. CONCLUSIONS: RNFL thinning was present in corresponding hemifields of glaucomatous eyes with minimal visual field defect and correlated with visual field sensitivity loss. Measurement of RNFL thickness has potential for detection of early nerve fiber loss owing to glaucoma.     

Optic nerve head topographic measurements and retinal nerve fiber layer thickness in physiologic large cups

PURPOSE: To evaluate the parameters of optic nerve head (ONH) and retinal nerve fiber layer (RNFL) in patients with large cup/disc ratio (CDR) and normal neuroretinal rim configuration who have normal perimetry (physiologic large cups, LC) and to compare these parameters with those of the normal and early glaucoma patients. METHODS: Using Heidelberg retinal tomography (HRT) and optical coherence tomography (OCT), 30 patients with LC, 29 normal subjects, and 31 early glaucoma patients were examined. One eye from each subject was randomly selected. RESULTS: Significant differences between LC and glaucomatous eyes (GE) were found in parameters indicating loss of nerve fibers, such as rim area, rim volume, and mean RNFL thickness. However, there was no difference between LC and normal eyes (NE) in RNFL thickness, rim area, and rim volume. LC was able to be defined as a normal central excavation with a large disc and large CDR with a normal rim area. CONCLUSIONS: HRT ONH parameters and RNFL thickness obtained with OCT may be useful for differentiating between glaucoma and LC eyes.