Abstract
BackgroudTo determine whether diffuse retinal nerve fiber layer (RNFL) defects, identified on red-free fundus photographs, could be identified on optical coherence tomography (OCT) en face structural images and to evaluate which factors are related to the different recognition patterns on en face images.MethodsThis retrospective, cross-sectional study included open-angle glaucoma eyes with diffuse RNFL defects in the inferior hemifield, identified in red-free photographs. The corresponding OCT en face structural images were divided into 3 groups: (1) no defect, (2) localized defect, and (3) diffuse defect. We compared the demographic and clinical ocular characteristics among the groups.ResultsA total of 209 eyes from 157 patients were included. The distribution of OCT en face images was: no defect, 25 eyes (11.96%); localized defect, 106 eyes (50.72%); diffuse defect, 78 eyes (37.32%). Logistic regression analysis revealed that eyes with greater mean deviation (P = 0.004) and thicker inferior RNFL (P = 0.008) would be included in the no defect and localized defect groups based on OCT en face images, rather than in the diffuse defect group.ConclusionAround half of diffuse RNFL defects identified in the red-free photographs appeared as localized defects in OCT en face images. Mild glaucomatous damage was related to no defect and localized defect groups, classified based on the OCT en face images, in eyes with diffuse photographic RNFL defects. OCT en face images may be helpful in further assessing diffuse RNFL defects seen in red-free photographs in eyes with open-angle glaucoma.
Highlights
Glaucoma shows morphological changes to the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) by progressive loss of retinal ganglion cells [1]
We evaluated the pattern of diffuse RNFL defect, as determined by red-free fundus photography, using optical coherence tomography (OCT) en face structural images
The 209 eyes with diffuse defects of the inferior hemifield in red-free photography were categorized into one of the three groups based on the defect seen in the en face images: no defect, localized defect, or diffuse defect
Summary
Glaucoma shows morphological changes to the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) by progressive loss of retinal ganglion cells [1]. Red-free fundus photography helps to detect glaucomatous RNFL defects [5], which can be appeared as a dark stripe or wedge-shaped localized defect in the peripapillary area, parallel to the normal retinal striation, or as a diffuse loss of this striation [4,5,6]. Both localized and diffuse loss can be an initial sign of glaucomatous damage [7]. Using red-free fundus photography alone, it is difficult to detect mild glaucoma with diffuse RNFL defect [8]
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