Pattern of retinal nerve fiber layer damage in Korean eyes with normal-tension glaucoma and hemifield visual field defect

PURPOSE: To evaluate quantitatively the pattern of retinal nerve fiber layer (RNFL) damage in eyes with normal-tension glaucoma (NTG) with hemifield dominant visual field defects using scanning laser polarimetry. METHODS: Prospectively, 40 consecutive eyes from 40 patients with NTG and hemifield defect based on the findings of examination using the Humphrey Field Analyzer underwent RNFL thickness measurements. Twenty normal eyes from 20 subjects matched in age and refractive error formed a control group. RESULTS: Symmetry, calculated as the ratio of superior to inferior RNFL thickness, showed no statistically significant difference between the study group and the control group ( P=0.50). Overall, 27.5% (11/40 eyes) showed an "abnormal" symmetry index that indicated focal RNFL change. The affected ratio, calculated as the ratio of RNFL thickness in the quadrant corresponding to the hemifield of visual field defect to that of the temporal quadrant was significantly lower in the study group than in the control group ( P<0.0001). A similar finding was noted for the unaffected ratio. CONCLUSION: Despite strict selection of the eyes with visual field defect confined to one hemifield, a mixture of both focal and diffuse RNFL damage was noted, with a common occurrence of symmetrical RNFL thinning in both upper and lower quadrants based on scanning laser polarimetry.     

Retinal nerve fiber layer thickness in amblyopic eyes

PURPOSE: To compare the peripapillary retinal nerve fiber layer (RNFL) thickness of sound and amblyopic eyes. DESIGN: Prospective observational case series. METHODS: Setting: Institutional. Study population: Patients with unilateral strabismic, anisometropic, or combined amblyopia. Observation: Fast RNFL analysis with ocular coherence tomography (OCT) of sound and amblyopic eyes. Measure: Mean RNFL thickness. RESULTS: For the 17 patients (mean age 10.7 years) in whom both eyes were imaged, the mean thickness of the sound eye was 109.2 microm (median 112.7) and of the amblyopic eye was 104.2 microm (median 105.0), and the average difference (sound eye less amblyopic eye) was 5.0 microm (median 3.0) (95% confidence interval -2.3, 12.2, P = .17). The sound eye was 10 microm or more thicker than the amblyopic eye in four patients; the amblyopic eye was 10 microm or more thicker than the sound eye in one patient; and the difference was within 10 microm in 12 patients. Test-retest data were obtained for 23 pairs of sound eyes and 21 pairs of amblyopic eyes, with 75% of the test-retest pairs within 7%. CONCLUSIONS: We found a small, but not clinically significant, difference in nerve fiber layer (NFL) thickness between amblyopic and sound eyes. Reliability was excellent, with most eyes testing within 7% of the first test.     

Retinal nerve fiber layer thickness in human eyes

· Background: A study was carried out to measure the thickness of the retinal nerve fiber layer (RNFL) at the optic disc border. · Methods: RNFL thickness at the optic disc border was histomorphometrically measured on histological sections of 22 human eyes with normal optic nerves and 21 human eyes with absolute secondary angle-closure glaucoma. For three eyes with normal optic nerves, serial sections through the whole optic disc area were available. · Results: In the eyes with normal optic nerves, the RNFL at the optic disc border showed a double hump configuration with the highest mean thickness in the inferior quadrant (mean ± S.D: 266±64 μm), followed by the superior quadrant (240±57 μm), the nasal quadrant (220±70 μm), and finally the temporal quadrant (170±58 μm). In the three globes with serial sections, RNFL was thickest at the inferior disc pole (397±58 μm), followed by the superior disc pole (313±38 μm), the nasal disc pole (165±19 μm), and finally the temporal disc pole (131±15 μm). In the eyes with absolute glaucoma, mean thickness of the remainder of the RNFL was 40±18 μm with no marked differences between the disc regions. · Conclusions: In normal eyes, the RNFL shows a double hump configuration with its thinnest part at the temporal disc pole, followed by the nasal disc pole and the superior disc pole. RNFL is thickest at the inferior disc pole. In glaucomatous optic neuropathy, the inner limiting membrane moves backward about 60–100 μm at the temporal disc border, and more than 200 μm at the inferior and superior disc poles. Received: 24 July 1998 Revised version received: 29 September 1998 Accepted: 22 October 1998     

Retinal nerve fiber layer thickness in unilateral amblyopia

PURPOSE: To test the hypothesis that eyes with amblyopia may have thicker retina, retinal nerve fiber layer thickness (RNFLT) was investigated in patients with unilateral amblyopia. METHODS: Thirty-eight patients with unilateral amblyopia were studied. Among them, 20 patients had amblyopia with strabismus and 18 had refractive amblyopia without strabismus. Nineteen of 38 had anisometropia of 2.0 D or more. In addition, 17 patients with anisometropia of 2.0 D or more but without amblyopia were enrolled as control subjects. RNFLT was measured by optical coherence tomography with scan pattern "Nerve Head 2.0R" (Carl Zeiss Meditec, Dublin, CA). Average RNFLT was multiplied with their corresponding scan circumferences to estimate the integral values of the total RNFL area (RNFLT(estimated integrals)). RESULTS: In all 38 patients with unilateral amblyopia, the difference in RNFLT and in RNFLT(estimated integrals) between the amblyopic eyes and the normal fellow eyes were statistically significant. Multivariate regression analysis with adjustment for axial length, spherical equivalence, age, and sex indicated significant differences as well. In the group of strabismic amblyopia, the difference in RNFLT and in RNFLT(estimated integrals) between the amblyopic eyes and the normal fellow eyes did not reach statistical significance. However, in the group of refractive amblyopia, the difference in RNFLT and in RNFLT(estimated integrals) between the amblyopia eyes and the normal fellow eyes both had a statistical significance. In the 19 patients with anisometropic amblyopia, the difference in RNFLT and in RNFLT(estimated integrals) between the amblyopic eyes and the normal fellow eyes were statistically significant. In the control group of 17 patients with nonamblyopic anisometropia, the difference in RNFLT and in RNFLT(estimated integrals) between both eyes did not reach statistical significance. CONCLUSIONS: RNFLT may be affected by refractive amblyopia, but further histopathologic confirmation is needed.     

Retinal nerve fiber layer measures in high- and normal-tension glaucoma.

PURPOSE: To use optical coherence tomography (OCT) to investigate the qualitative and quantitative differences in the defects of the retinal nerve fiber layer (RNFL) in subjects with high tension primary open angle glaucoma and subjects with normal tension glaucoma. METHODS: RNFL was assessed with OCT in 21 eyes with high-tension glaucoma (HTG) and 20 eyes with normal-tension glaucoma (NTG). Regression analyses were performed to investigate the interaction of disease group and location for localized RNFL loss, and to predict diffuse and localized RNFL loss as a function of age, mean defect, spherical equivalent, disease group, and location. Local RNFL thicknesses for superior clock-hour regions were estimated after adjustment for the thicknesses of symmetrically opposed locations. RESULTS: There were no differences in mean age, visual field defect mean deviation, and refractive error between subjects in HTG and NTG groups. Diffuse RNFL thickness was not significantly different between the two groups [mean RNFL for NTG > HTG by 3.48 mum, 95% confidence interval (CI) -3.9 to 10.9 microm, p = 0.092]. There was no significant interaction of group and location for localized RNFL loss (p = 0.916). Local RNFL thickness at superior regions was not significantly different in the two groups, after adjustment for RNFL thickness at corresponding inferior locations (mean RNFL for NTG > HTG by 6.30 microm, 95% CI -1.08 to 13.7 microm, p = 0.34). RNFL thickness decreased, on average (1.88 microm/dB mean deviation, 95% CI 1.21 to 2.55 microm, p < 0.0001) and locally (1.37 microm/dB mean deviation, 95% CI 0.79 to 1.96 microm, p < 0.0001), with increasing severity of glaucoma. CONCLUSION: There is no difference in the spatial pattern of RNFL defects, as assessed by the OCT, between HTG and NTG.     

Relationship between central corneal thickness and localized retinal nerve fiber layer defect in normal-tension glaucoma

PURPOSE: To determine whether central corneal thickness (CCT) is related to the extent of localized retinal nerve fiber layer (RNFL) defect at the initial examination of normal-tension glaucoma (NTG) patients. PATIENTS AND METHODS: Seventy-five eyes of 75 NTG patients showing localized RNFL defects on RNFL photographs and corresponding visual field defects at the initial visit to a glaucoma specialist were selected for this study. All participants completed refraction, Goldmann applanation tonometry, CCT measurement, stereoscopic disc photography, RNFL photography, and automated perimetry. Each patient's age, spherical equivalent, intraocular pressure, CCT, approximation of the RNFL defect to the fovea (angle alpha), circumferential width of the RNFL defects (angle beta), horizontal and vertical cup-to-disc ratios, and mean deviation of visual field were analyzed. RESULTS: In univariate and multivariate analyses, lower CCT was significantly associated with increased horizontal and vertical cup-to-disc ratios, decreased angle alpha, and increased angle beta. For a decrease of 10 microm of CCT, horizontal and vertical cup-to-disc ratios increased by 0.020, angle alpha decreased by 1.58 degrees, and angle beta increased by 1.71 degrees, respectively. CONCLUSION: CCT is a significant factor in predicting the extent of localized RNFL defect at the initial examination of NTG patients.     

Central corneal thickness and visual field loss in fellow eyes of patients with open-angle glaucoma

PURPOSE: To determine the relationship of central corneal thickness (CCT) and visual field loss between fellow eyes in primary open-angle glaucoma. DESIGN: Retrospective, observational case series. METHODS: Records review of glaucoma patients seen at local Veterans Administration eye clinic. Those with CCT measurements performed within one month of visual field testing were included. Patients were excluded with vision below 20/40 or disease that would affect visual fields. Intrasubject (between fellow eyes) differences in CCT, mean deviation (MD), and pattern standard deviation (PSD) were calculated by subtracting left eye value from right eye value. RESULTS: Of the 100 subjects (94 males), the Spearman correlation coefficient between intrasubject differences in CCT vs intrasubject differences in MD was 0.36 (P = .0003). The Spearman correlation for differences in CCT vs differences in PSD was -0.31 (P = .0019). CONCLUSIONS: Our study suggests that worse visual field changes tend to occur in the eye with the thinner cornea.     

Study of retinal nerve fiber layer thickness within normal hemivisual field in primary open-angle glaucoma and normal-tension glaucoma

PURPOSE: To determine if nerve fiber layer thickness (NFLT) in glaucoma patients decreases before the development of visual field loss, and if there is a difference in the thinning of NFLT between primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG) eyes. METHODS: Thirty patients (33 eyes) with POAG and 31 patients (31eyes) with NTG, who had visual field defects localized in either the upper or the lower hemifield verified by Humphrey Field Analyzer (HFA), were measured for NFLT by scanning laser polarimetry (Nerve Fiber Analyzer). Twenty-three normal subjects (23 eyes) matched in refraction and age with the glaucoma patients were recruited as the control group. The total deviation (TD) in each hemifield obtained by HFA and the 180 degrees NFLT of each corresponding hemifield was calculated. Relationships between the TD of the normal or abnormal visual hemifield and the NFLT of the corresponding hemifield were compared among the POAG, NTG, and control groups. RESULTS: The NFLT of the corresponding normal hemifield was decreased both in the POAG group and in the NTG group when compared with the corresponding measurements in control subjects. In POAG eyes, thinning of the NFLT in the corresponding normal hemifield was more remarkable if the TD of the abnormal hemifield was greater, but this tendency was not observed in NTG eyes. CONCLUSION: NFLT is already decreased when the visual field is still normal both in POAG eyes and in NTG eyes. However, the pattern of retinal nerve fiber layer damage in POAG may differ from that in NTG.     

Prevention of visual field defect progression with angiotensin-converting enzyme inhibitor in eyes with normal-tension glaucoma

PURPOSE: To report the effect of angiotensin-converting enzyme (ACE) inhibitor on visual field changes in normal-tension glaucoma (NTG). DESIGN: Retrospective observational case series. METHODS: We retrospectively reviewed a total of 38 patients with NTG. Control subjects had no previous history of hypertension. NTG hypertension patients were divided into two groups, those receiving ACE inhibitor and those receiving other antihypertensive drug treatments. HfaFiles 5, an analytical program for the Humphrey Field Analyzer, was used to calculate the slope for the mean deviation (MD) change per year. RESULTS: In the ACE inhibitor-treated group, the mean MD change per year was 0.48 +/- 0.19 dB, in control subjects was -0.38 +/- 0.23 dB, and in the other antihypertensive drug-treated group was -0.50 +/- 0.39 dB. CONCLUSIONS: Although the present study is retrospective and the sample size is small, ACE inhibitor might have a favorable effect on the visual field in patients with NTG in this small study.     

Relationship between progression of visual field damage and choroidal thickness in eyes with normal-tension glaucoma

Background: To measure choroidal thickness in normal eyes and in patients with normal‐tension glaucoma using enhanced depth imaging optical coherence tomography and evaluate the association between choroidal thickness and progression of visual field damage. Design: Cross‐sectional comparative study. Participants: A total of 62 eyes of 62 normal subjects and 45 eyes of 45 normal‐tension glaucoma patients were examined. Methods: The choroid was measured at the fovea and 3 mm nasal and temporal from the fovea. In the separate study, both eyes of the patients with normal‐tension glaucoma were included in the analyses. Visual fields were measured with automated perimetry. Changes in mean deviation per year (dB/year), that is, mean deviation slope, were calculated. Main Outcome Measures: Difference in the choroidal thickness between the normal subjects and the patients with normal‐tension glaucoma. The relationship between mean deviation slope and the choroidal thickness in eyes with normal‐tension glaucoma was analysed. Results: Compared with normal subjects, the choroidal thickness was significantly thinner in eyes with normal‐tension glaucoma at 3 mm nasal from the fovea (P = 0.02). There was a significant correlation between the choroidal thickness at 3 mm nasal from the fovea and the mean deviation slope (Pearson's r = 0.413; P < 0.001). Conclusion: The decrease in the thickness of the choroid at 3 mm nasal from the fovea in eyes with normal‐tension glaucoma may be associated with progressive visual field loss. Thus, choroidal abnormalities may play a role in the pathogenesis of normal‐tension glaucoma.     

原发性开角型青光眼与慢性原发性闭角型青光眼视网膜神经纤维层厚度与视野缺损的关系

目的 探讨原发性开角型青光眼(primary open-angle glaucoma,POAG)和慢性原发性闭角型青光眼(chronic primary angle-closure glaucoma,CPACG)患者频域光学相干断层扫描(optical coherence tomography,OCT)检测的视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度与视野平均缺损(mean defect,MD)的相关性.方法 采用RTVue100-2频域OCT和OCTO-PUS101视野计对POAG患者22例(22眼)及CPACG患者22例(22眼)进行检测,将两组患者RNFL厚度及视野MD值进行比较,应用Pearson积矩相关分析法确定RNFL厚度与视野MD值、上方和下方RNFL厚度与相对应半侧视野MD值的相关性.结果 POAG患者RNFL厚度、上方RNFL厚度及下方RNFL厚度分别为(91.19±15.85)μm、(94.93±18.76) μm、(87.82±15.65) μm,CPACG患者相应的RNFL厚度分别为(88.22±13.01) μm、(90.41±14.16)μm、(86.49±16.63) μm,两组患者各RNFL参数的比较差异均无统计学意义(均为P＞0.05).POAG组总MD值、上方半侧视野MD值、下方半侧视野MD值分别为(8.41±6.07)dB、(8.46±5.39)dB、(6.79±6.67) dB,CPACG组相应的MD值分别为(10.69±3.76) dB、(11.17±3.52) dB、(9.71±5.86)dB,两组患者各MD参数比较,差异均无统计学意义(均为P＞0.05).POAG组总RNFL厚度、上方RNFL厚度及下方RNFL厚度与视野相对应区域MD值呈中度负相关(r分别为:-0.574、-0.464、-0.600,均为P＜0.05),CPACG组总RNFL厚度、上方RNFL厚度及下方RNFL厚度与视野相应区域MD值呈高度负相关(r分别为-0.819、-0.884、-0.812,均为P =0.000);两组患者RNFL厚度与MD的相关系数和下方RNFL厚度与上方半侧视野MD的相关系数的差异均无统计学意义(P＞0.05),两组患者上方RNFL厚度与下方半侧视野MD的相关系数的差异有统计学意义(P＜0.05).结论 POAG患者RNFL厚度与视野MD呈中度负相关,CPACG患者RNFL厚度与视野MD呈高度负相关;相对于POAG患者,CPACG患者上方RNFL厚度与下方半侧视野MD具有更好的相关性.     

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.     

Evaluation of visual field changes with retinal nerve fiber layer thickness in primary congenital glaucoma

Purpose:To evaluate visual field changes in primary congenital glaucoma (PCG) with retinal nerve fiber layer thickness on optical coherence tomography.Methods:In this cross-sectional, observational study, consecutive PCG children who underwent combined trabeculotomy with trabeculectomy and on regular follow-up were enrolled. All patients were aged over four years and co-operative for RNFL OCT and visual field examination. Perimetry was done on Humphrey visual field (HVF) analyzer using 30-2 and 10-2 SITA standard algorithms as appropriate. If a reliable automated perimetry was not feasible, kinetic perimetry was done. The following were noted at baseline and every follow-up: age, sex, visual acuity, intraocular pressure (IOP), cup–disc ratio (CDR), corneal diameters, refraction, any topical antiglaucoma medications, surgeries underwent, age at surgery and duration between surgery and final examination.Results:Forty-eight eyes of 34 children operated for PCG and 19 eyes of 17 controls were analyzed. A statistically significant thinner average RNFL thickness of 87.2 ± 28 μm was noted in PCG eyes as compared to controls with 100.6 ± 7.2 μm (P = 0.04). The mean cup–disc area ratio on OCT in PCG eyes was 0.43 ± 0.2 (0.02–0.93) and in control eyes was 0.23 ± 0.07 (0.1–0.4) (P < 0.001). On RNFL OCT, there was significant focal RNFL loss in temporal superior (P = 0.003), nasal inferior (P = 0.037) and temporal inferior (P < 0.001) quadrants compared to controls. Among PCG eyes, 20/48 eyes (41.7%), had definitive, reproducible glaucomatous VF defects. Mean baseline IOP in PCG eyes with VF defect was 28.7 ± 5.7 mmHg and in eyes with normal VF was 24.6 ± 5.9 mmHg (P = 0.03). On univariate regression analysis, higher baseline IOP was significantly associated with both RNFL loss (odds ratio (OR): −2.17) and VF defects (OR: 3.35). Fluctuation in follow-up IOP (OR: 3.33) was also significantly associated with the presence of VF defects. On multivariable regression analysis maximum, IOP was significantly associated with RNFL loss and VF defects.Conclusion:Peripapillary RNFL thickness could be used to identify PCG eyes having visual field loss and possibly poor visual function from PCG eyes without visual field defects. Baseline and follow-up IOP, significantly correlated with RNFL thickness in PCG eyes.     

青光眼视网膜神经纤维层厚度变化及其与视野缺损的相关性

目的　利用光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）检测早期原发性开角型青光眼和可疑青光眼患者视网膜神经纤维层（ｒｅｔｉｎａｌｎｅｒｖｅｆｉｂｅｒｌａｙｅｒ,ＲＮＦＬ）厚度的变化,并分析其与视野缺损的相关性。方法　收集来我院就诊的可疑青光眼患者３５例（６３眼）为Ａ组,早期原发性开角型青光眼患者４１例（７２眼）为Ｂ组,对照组３４例（６６眼）为Ｃ组,采用ＯＣＴ仪和Ｈｕｍｐｈｒｅｙ７４０ｉ全自动视野计分别对３组受检者进行视盘周围ＲＮ-ＦＬ厚度和视野检测,比较３组患者的ＲＮＦＬ厚度,分析青光眼组ＲＮＦＬ厚度与视野缺损间的关系。结果　Ａ组的上方、下方象限及平均ＲＮＦＬ厚度与Ｃ组对应象限比较,差异均有统计学意义（均为Ｐ＜０．０５）;Ｂ组与Ｃ组比较平均及各象限ＲＮＦＬ厚度差异均有统计学意义（均为Ｐ＜０．０５）;Ａ组与Ｂ组比较上方、下方、鼻侧象限及平均ＲＮＦＬ厚度差异均有统计学意义（均为Ｐ＜０．０５）。三组受检者各象限及全周视野缺损两两比较,差异均有统计学意义（均为Ｐ＜０．０５）。Ｂ组平均及各象限ＲＮＦＬ厚度与视野缺损程度均呈负相关（均为Ｐ＜０．０５）。结论　青光眼患者ＲＮＦＬ厚度变薄,并且与视野缺损程度呈负相关。     

Evaluation of relationship between retinal nerve fiber layer thickness progression and visual field progression in patients with glaucoma

Purpose

To evaluate the capability of optical coherence tomography (OCT), retinal nerve fiber layer (RNFL) thickness, and visual field (VF) measurements in glaucoma progression detection.

Methods

The study examined 62 eyes of 37 glaucoma patients observed over a 3-year period. All eyes underwent at least four serial RNFL measurements performed by Cirrus OCT, with the first and last measurements separated by at least 3 years. VF testing was performed by using the Swedish interactive threshold algorithm (SITA) Standard 30-2 program of the Humphrey field analyzer (HFA) on the same day as the RNFL imaging. Both serial RNFL thicknesses and VF progression were assessed by the guided progression analysis (GPA) software program. RNFL thickness progression was evaluated by event analysis. Total deviation (TD) in the superior or inferior hemifield was also examined.

Results

A total of 295 OCT scans and 295 VFs were analyzed. Five eyes exhibited progression by OCT only and 8 eyes exhibited progression by VF GPA only. When the analysis was based on the combined measurement findings, progression was noted in 6 eyes. The average of the progressive hemifield TD at baseline for combined RNFL and VF progression was ?3.21 ± 1.38 dB, while it was ?2.17 ± 1.14 dB for RNFL progression and ?9.12 ± 3.75 dB for VF progression. The average of the progressive hemifield TD indicated a significant advancement of VF progression as compared to RNFL progression (P = 0.002).

Conclusions

When a mild VF defect is present, OCT RNFL thickness measurements are important in helping discern glaucoma progression.