Diffuse Glaucomatous Structural and Functional Damage in the Hemifield Without Significant Pattern Loss

Abstract

To compare the retinal nerve fiber layer (RNFL) thickness and retinal sensitivity in the normal visual hemifield of glaucomatous eyes with localized visual field loss with those of normal eyes and eyes with suspected glaucoma, and to evaluate the relationship between RNFL atrophy and glaucoma severity. Methods: One randomly selected eye of each subject underwent standard automated perimetry, stereoscopic photography, scanning laser polarimetry with enhanced corneal compensation, and time-domain and spectral-domain optical coherence tomography (OCT). Mean retinal sensitivity values were calculated in the normal standard automated perimetry hemifield of the glaucoma group and randomly selected hemifields in the normal and suspected glaucoma groups. The mean RNFL thickness values corresponding to the normal hemifield were calculated. Glaucoma severity was judged using standard automated perimetry pattern standard deviation and the Heidelberg retina tomograph-derived linear cupdisc ratio. Results: Fifty subjects were enrolled in each group. Mean RNFL thickness in the normal hemifield obtained using spectral-domain OCT, time-domain OCT, and scanning laser polarimetry with enhanced corneal compensation was significantly (PՅ.01) thinner in the glaucoma group compared with the normal and suspected glaucoma groups. Mean retinal sensitivity in the normal hemifield was significantly (PϽ.001) reduced in the glaucoma group compared with the normal and suspected glaucoma groups. The Heidelberg retina tomograph-derived cup-disc ratio was significantly correlated with mean RNFL thickness in the normal hemifield obtained using spectral-domain OCT, time-domain OCT, and scanning laser polarimetry with enhanced corneal compensation (PՅ.01). Conclusions: Diffuse RNFL atrophy and retinal sensitivity loss exist in glaucomatous eyes with localized standard automated perimetry deficits. Glaucomatous damage affects both structure and function in a linear proportion.

Detection of macular and circumpapillary structural loss in normal hemifield areas of glaucomatous eyes with localized visual field defects using spectral-domain optical coherence tomography

“…Furthermore, several studies have shown the presence of glaucomatous cRNFL defects in the retinal segments corresponding to intact hemifields, using various imaging devices including TD-OCT or SD-OCT [15][16][17][18][19][20][21][22]. Our current study using RTVue-100 SD-OCT has confirmed these findings.…”

Correlation between nerve fibre layer thickness measured with spectral domain OCT and visual field in patients with different stages of glaucoma

“…Our findings are consistent with the results of a previous study, which showed that eyes with visual field loss in one visual hemifield have diffuse attenuation of RNFL thickness in apparently normal areas of visual field. In this study, significant correlation was found between visual field parameter pattern standard deviation and mean RNFL thickness in the normal hemifield, using time-domain and SD-OCT [17]. Despite higher resolution and faster scanning speed of SD-OCT, the strength of structure-function association is no different from time-domain OCT [5,17].…”

Macular Retinal Ganglion Cell Complex Damage in the Apparently Normal Visual Field of Glaucomatous Eyes With Hemifield Defects

“…[17][18][19][20][21][22] Such studies have led to speculation that the mGCC of glaucomatous eyes also exhibit diffuse atrophy in normal visual hemifields with localized visual field loss. In this study, we investigated this hypothesis by examining and comparing glaucomatous eyes with normal eyes.…”