Disc-fovea Angle Is Associated With Visual Field Defect Location in Patients With Glaucoma

Abstract

Precis: The current study showed that glaucomatous eyes from patients with central visual field defects presented less negative disc-fovea angle compared with patients with peripheral defects. Purpose: The purpose of this study was to investigate the relationship between disc-fovea angle and visual field defect location in patients with glaucoma. Materials and Methods: This was a cross-sectional study including glaucoma patients divided into isolated central and isolated peripheral scotoma groups. The main outcome measure was disc-fovea angle measurement between groups. Secondary outcomes included disc-fovea distance, vertical disc diameter, and fovea vertical deviation. Results: We included 50 glaucoma patients (50 eyes; 27 with central scotoma and 23 with peripheral scotoma). Mean deviation from visual fields was −3.05±1.67 and −2.95±1.49 dB (P=0.829) (central and peripheral scotoma groups, respectively). We found that eyes in the central group had lower values of disc-fovea angle (−5.85±2.67 vs. −7.97±2.26 degrees, P=0.004), shorter disc-fovea distance (4.38±0.70 vs. 4.98±0.78 mm, P=0.006), and shorter fovea vertical deviation (−0.43±0.19 vs. −0.68±0.22 mm, P<0.001) compared with eyes in the peripheral group. Conclusions: This study showed an association between disc-fovea angle and central visual field defects in patients with glaucoma. Our findings suggest that eyes with a less negative disc-fovea angle should undergo a more careful investigation of the central visual field, even at early stages of the disease.

Anatomic and refractional correlations in earliest glaucomatous visual field defects

“…In our assessment, the average DFA found (-7.66° ± 3.40°) was higher than that found by other authors (11,14) , but between the evaluated groups (myopic vs. hyperopic), the DFA had no statistical difference. Also, comparing the groups with the highest and lowest DFA (Table 2), there was no significant association with the initial defect location.…”

“…Central scotomas can impact more intensely on daily activities and should be treated with greater rigor (11) . In our research, we had a greater number of scotomas in the superior hemicampus compared to the inferior hemicampus, especially when referring to central scotomas (4 inferior vs. 14 superior).…”

“…Negative angulation below the midline joining the center of the optic nerve and the macula was considered. We used -7° as the division between groups as this is the average DFA found in studies (11,14) .…”

“…Also, systemic and refractive anatomical variations, mostly of the posterior pole, directly influence the initial location of the visual field defect (8) . The anatomical position of the fovea and its relationship between distance and angulation to the optic nerve can affect macular RNFL distribution (9) and the disk-fovea angle (DFA) (10,11) , as the axial length (LA) promotes increased risk of central visual field lesions (12) .…”

The Relationship Between Optic Disc and Retinal Artery Position and Glaucomatous Visual Field Progression

“…For instance, Abe et al suggested a less negative disc-fovea angle was associated with more advanced central visual field damage. 31 This was also observed in a separate study. 32 However, an epidemiological study in Japan showed no difference in the papillomacular bundle tilt angle between normative and glaucomatous eyes.…”