Early Visual Field Defects Research Articles

Commentary: Rethinking 10-2 visual fields in early diagnosis of glaucoma for a glided glaucoma practice: The right choice to pick up a feeble noise?

Commentary: Rethinking 10-2 visual fields in early diagnosis of glaucoma for a glided glaucoma practice: The right choice to pick up a feeble noise?

Factors associated with glaucoma-specific quality of life in a US glaucoma clinic in a pilot implementation of an online computerised adaptive test (GlauCAT)

ObjectivesMeasure quality of life (QoL) outcomes using a novel computerised adaptive test in a clinical setting, and determine the social and demographic factors associated with specific QoL domains in patients...

Effect of palmitoylethanolamide on inner retinal function in glaucoma: a randomized, single blind, crossover, clinical trial by pattern-electroretinogram

Glaucoma is a neurodegenerative disease, our study aimed to evaluate the potential effects of Palmitoylethanolamide (PEA) supplementation on RGCs function by PERG examination, and to record effects on intraocular pressure, visual field and quality of life. It was a single centre, randomized, prospective, single blind, two treatment, two period crossover study on stable glaucoma patients on topical monotherapy comparing current topical therapy alone or additioned with PEA 600 mg one tablet a day. At baseline, at 4 and at 8 months, all patients underwent to complete ophthalmic examination, pattern electroretinogram, visual field, and quality of life evaluation. 40 patients completed the study: mean age 66.6 ± 7.6 years; 21 (52.5%) male; 35 POAG (87.5%). At baseline, most patients had an early visual field defect, the IOP was well controlled. At the end of the PEA 600 mg supplementation, a significantly higher (mean 0.56 μV, 95% CI 0.30–0.73, p < 0.001) in the P50-wave amplitude was observed; in the PEA period a significantly lower IOP (− 1.6 mmHg, 95% CI − 2 to 1.2, p < 0.001) and higher quality of life scores (+ 6.7, 95% CI 4–9.9, p < 0.001) were observed. Our study is the first to show promising effects of PEA on PERG and on quality of life in glaucoma patients.

Relationships among retinal/choroidal thickness, retinal microvascular network and visual field in high myopia.

To determine the relationships among retinal/choroidal thickness, retinal microvascular network and visual field in high myopia. This cross-sectional study included a total of 62 subjects, comprising 31 eyes with high myopia and 31 eyes with emmetropia or low myopia. Optical coherence tomography was used to quantify the thickness of ganglion cell complex (GCC), inner nuclear layer and outer plexiform layer (INOPL), outer retinal layer (ORL) and choroid layer (ChL). Optical coherence tomography angiography was used to quantify the superficial vessel density (SVD) and deep vessel density (DVD). Retinal light sensitivity (RLS) was measured by microperimetry-1 (MP1). The inner ring (1-1.75mm), the outer ring (1.75-2.5mm) and the whole ring (1-2.5mm) around the macula were analysed and compared between the two groups. Pearson correlation analysis was performed to analyse the relationship among them. In the highly myopic group, the thinning of retinal/choroidal thickness and the decrease in retinal vessel density and RLS were found when compared to the emmetropia or low myopia (p<0.05). Decreased RLS was correlated with decreased ORL thickness (r=-0.469, p=0.008) and choroid thickness (r=0.398, p=0.030). There was no correlation between retinal microvascular network parameters and RLS (p>0.05), but DVD showed a negative correlation with ORL (r=-0.474, p=0.007). Early visual field defects in highly myopic eyes may be influenced by the ORL loss and defect of choroidal circulation. The deep retinal microvascular network may have a compensatory action in the hypoxic setting of high myopia.

Long-Term Follow-Up of Normal Tension Glaucoma Patients With TBK1 Gene Mutations in One Large Pedigree

To characterize features of glaucoma associated with a TANK binding kinase 1 (TBK1) gene duplication, which is among the most common molecularly defined causes of normal tension glaucoma (NTG). Retrospective observational case series. We conducted a retrospective case series, by reviewing medical records of 7 members of a pedigree with NTG caused by TBK1 gene duplications. Clinical features of these patients at diagnosis, throughout management, and at latest follow-up were identified, including age, intraocular pressure (IOP), central corneal thickness (CCT), optic nerve head appearance, and mean deviation (MD) assessed with Humphrey visual field (HVF) testing protocols. At initial diagnosis, the mean age was 35 ± 7 years, IOP was 16 ± 2.1mm Hg, cup-to-disc (C/D) ratio was 0.9 ± 0.08, and MD assessed via HVF 30-2 and/or 24-2 testing protocols was-9.0 ± 8.9 (range:-1.8 to-27) dB in the 14 study eyes. At initial diagnosis, 4 of 14 eyes (28%) had no visual field defect, 4 (28%) had early visual field defects, and 6 (43%) had severe visual field defects. Patients had a mean follow-up of 21.5 ± 9.0 years and experienced an average reduction of IOP by 28%. Four of 12 eyes (33%) had stable visual fields throughout follow-up, while 8 eyes (67%) had slow-to-moderate progression. The 30-2 and/or 24-2 HVF tests had an average change in MD of-0.53 ± 0.26 dB/year. No eyes had rapid progression with an MD >1.0 dB/year. At final follow-up, the mean IOP was 11.5 ± 2.9, and C/D ratio was 0.94 ± 0.4. At final follow-up, 3 of 14 eyes (21%) had early visual field defects, 4 (29%) had moderate visual field defects, and 7 (50%) had severe visual field defects. Six of 14 eyes (43%) met criteria for legal blindness. We provide the first report of the clinical features and long-term clinical course in a family of NTG patients with TBK1 gene duplications. TBK1-associated glaucoma exhibits classic features of NTG. Patients present with severe disease at a relatively early age and most (67%) have slow-to-moderate progression of their visual field defects. The rate of visual field change appears correlated with the magnitude of IOP, suggesting that it may be advantageous to set extremely low IOP targets for some patients with TBK1-associated glaucoma.

The time relationship of retinal light threshold fluctuations and retinal nerve fiber layer and ganglion cell complex thickness changes on high-risk primary open-angle glaucoma

Objective To investigate the time relationship of the change, and diagnostic accuracy and sensitivity between retinal light threshold fluctuations (LTF) and retinal nerve fiber layer (RNFL) and ganglion cell complex(GCC) thickness on high-risk primary open-angle glaucoma (POAG). Methods Totally 319 patients (319 eyes) with high-risk in POAG from the First Affiliated Hospital of Kunming Medical Universityand during December 2009 and December 2017, 50 healthy individuals (50 eyes) as control were collected in this longitudinal cohort study. Visual field and OCT were reviewed every 6 months on the high-risk group and every 12 months on the control group. High-risk groups inclusion criteria: vertical C/D≥0.6; early visual field defect (according to glaucoma visual field damage GSS2 quantitative grading standards, mean deviation and pattern standard deviation of central field exceeds the border as an early visual field defect); continuous repeatable results. The first field and OCT results in the absence of visual field defects and C/D≥0.6, which were conformed reliability indicators and removed learning effects as a baseline. When patients achieve POAG diagnosis criteria first time which was recorded as a turning point. And they were divided into early group meanwhile were ended of follow-up. After the last follow-up, the inspection data was segmented counted in yearly interval. The changes of LTF, thickness of RNFL and GCC during the follow-up period in the early POAG group and the control group were observed. The loss rate and change rate in each period were compared for the assessment of their trends with time. Followed by calculation of the area under receiver operating curves (AUC) to compare the predicted value of POAG and the sensitivity at 95% specificity in each period. Results After last follow-up, totally 67 patients 67 eyes (early POAG group, 37 males and 30 females) were entered the turning point. The mean follow-up of the early POAG group and the control group were 6.6 and 6.4 years. The average RNFL thickness was 79.05±8.09 μm, GCC thickness was 71.58±8.41 μm, LTF was −6.05±7.02 dB in early POAG group. The average RNFL thickness was 93.49±6.24 μm, GCC thickness was 79.72±6.32 μm, LTF was −0.31±0.58 dB in the control group. The differences of LTF and the thickness of RNFL and GCC were statistically significant (t=−5.97, −10.42, −5.60; P<0.001). The AUC of RNFL, GCC thickness and LTF increased with time in the early POAG group. The sensitivity was gradually increased at 95% specificity: 5th year before to at turning point, RNFL thickness AUC was 0.15, 0.65, 0.71, 0.77, 0.85, 0.92, and sensitivity was 20%, 56%, 61%, 65%, 70%, 76%, respectively; GCC thickness AUC was 0.12, 0.53, 0.69, 0.74, 0.82, 0.90, and sensitivity was 14%, 53%, 69%, 74%, 82%, 90%, respectively; the AUC of LTF was 0.10, 0.21, 0.33, 0.75, 0.86, 0.91, and sensitivity was 7%, 17%, 44%, 65%, 78%, 87%, respectively. Conclusions The earliest time of structural functional damage of POAG is at the 4th year before confirmed, simultaneous RNFL diagnosis accuracy and sensitivity are better than GCC and LTF. The earliest time of visual functional damage of POAG is at the 2th year before confirmed, simultaneous LTF diagnosis accuracy and sensitivity are better than RNFL and GCC. Key words: Glaucoma, open-angle/diagnosis; Retinal light threshold fluctuation; Retinal nerve fiber layer thickness; Retinal ganglion cell complex thickness; Time relationship

Optic disc hemorrhages in glaucoma and common clinical features.

To analyze optic nerve head stereophotographs for the presence of optic disc hemorrhages, and to describe bleeding patterns and patient characteristics. Retrospective, cross-sectional study. 1113 optic nerve stereophotograph pairs of 562 consecutive patients. Stereophotographs were systematically reviewed for the presence of a disc hemorrhage with careful documentation of optic nerve head features. All charts of patients with hemorrhage were subsequently studied for demographic information and clinical data. Disc hemorrhages were observed in 7.1% of patients with optic disc photography. Most patients had open-angle glaucoma (57.5%) with focal ischemic phenotype of the optic disc (66.7%). The mean vertical and horizontal cup-disc ratios were 0.82 ± 0.14 and 0.76 ± 0.14, respectively. The β-zone peripapillary atrophy was observed in 48.9% of patients. The most common location was the inferotemporal region of the disc (60.8%), and most were flame or splinter shaped (70.6%). Disc hemorrhages were found either superficial to or within the retinal nerve fibre layer (72.5%), and in association with a notch (64.4%). The average intraocular pressure was 17.3 ± 4.9 mm Hg, and most hemorrhages were associated with early visual field defects (42.5%). Optic disc hemorrhages in patients with glaucoma were most frequently observed inferiorly in association with a notch. Most eyes with a disc hemorrhage had an intraocular pressure within normal range and had either early or no visual field loss. These findings highlight the importance of careful examination of the optic nerve head to look for the presence of a disc hemorrhage as an important biomarker of glaucoma damage.

Evaluation of Contrast Sensitivity, Chromatic Vision, and Reading Ability in Patients with Primary Open Angle Glaucoma.

Purpose. To compare contrast sensitivity, acquired color vision deficiency, and reading ability in patients with glaucoma at different stages of the disease and to establish correlations between visual field parameters and visual function scores. Methods. This prospective cross-sectional study included 121 glaucoma patients. Subjects with a diagnosis of chronic open angle glaucoma were recruited and classified according to Hodapp-Parrish-Anderson criteria. Patients with severe visual field defects were excluded because they were older, which could bias the interpretation of visual function tests. Contrast sensitivity was measured using the Pelli-Robson Chart and the CSV1000E test. Chromatic vision was evaluated using the Farnsworth-panel D15 and the L'Anthony D15 tests of Vision Color Recorder software. Reading ability was measured using Radner-Vissum test. Results. Contrast sensitivity (with photopic and mesopic luminance with glare) differed significantly between patients with early and moderate visual field defects (p < 0.05). Reading ability scores and results of the chromatic vision tests did not differ significantly between the two groups. Significant and moderate Spearman correlations between visual field indexes and contrast sensitivity tests were detected. Conclusions. Contrast sensitivity was significantly worse in patients with moderate glaucoma compared to those with early-stage glaucoma. Evaluation of visual function in clinical practice provides important information to address a glaucoma patient's vision complaints.

Spectral domain optical coherence tomography findings in pediatric tilted disk syndrome

To report a novel spectral domain-optical coherence tomography (SD-OCT) finding in children affected by tilted disk syndrome (TDS), and to correlate it with early visual field defects.

Comparison of visual field defects between newly detected chronic simple glaucoma and normotensive glaucoma

Objective : To study and compare the visual field defects in subjects with newly detected primary open angle glaucoma and normotensive glaucoma using HUMPHREY FIELD ANALYSER 30-2 swedish interactive thresholding algorithm(SITA) standard technique and to establish specific visual field loss patterns in each group and establish varied pathomechanisms. Methods: A prospective study 37 eyes of 25 patients with normal tension glaucoma(NTG) and chronic simple glaucoma(CSG). Patients were subjected to visual field testing using HUMPHREY FIELD ANALYSER(HFA) 30-2, SITA(Swedish interactive thresholding algorithm) standard method. Results: There was significant preponderance of early visual field defects in patients with NTG in comparison to patients with CSG (64% compared to 32.4%). Strong statistical differences were found in number of patients with scotomas falling with 6 degrees of central fixation (p<_0.001) in NTG comparing with CSG. Conclusion : results suggest that field defects between chronic simple and normotensive glaucoma do not differ in most aspects except for those in NTG group being closer to fixation and should not be used to underline different pathomechanisms in the two groups.

English

AIM: To study the proportion of patients with visual field defects in pituitary adenomas And to study the pattern of visual field defects in pituitary adenomas. MATERIALS AND METHODS: 24 patients diagnosed with a pituitary adenoma underwent complete ophthalmic and Humphrey's Perimetry 30 - 2 visual field test at Department of ophthalmology, M. S Ramaiah Hospital between November 2011 to May 2013. RESULTS: Among the 24 cases in the study, 3 cases were of pituitary micro adenoma constituting 12.5% and the remaining cases (21 cases) were pituitary macro adenoma, constituting 87.5%. Visual acuity of 6/6 - 6/12 were observed in 28 (58.3%) out of total 48 eyes. Visual field defects were observed in 19 cases (79%). Bilateral temporal hemianopia was observed in the majority (41%) of cases with field defects. One eye blind and contra lateral temporal hemianopia was observed in 20.8%. One eye temporal hemianopia and other eye involvement of 3 quadrants seen in 2 patients (8.4%). 5 patients had no visual field defects. CONCLUSION: Although ophthalmologists have a minor role in primary diagnosis of pituitary adenoma, routine ophthalmologic examination is very important. To detect early visual field defects, automated perimetry should be done as a part routine examination in patients with suspected pituitary

Spectral-domain optical coherence tomography findings in pediatric tilted disc syndrome.

To report a novel spectral-domain optical coherence tomography (SD-OCT) finding in children affected by tilted disc syndrome (TDS), and to correlate it with early visual field defects. Patients between 5 and 17 years old with TDS were enrolled in this study. The diagnosis of TDS was made by stereoscopic fundus photography, when the upper edge of the optic disc protruded anteriorly relative to its lower edge. All eyes were examined with 12 radial SD-OCT B-scans of 12 mm centered on the optic disc; the fundus area encompassing the optic nerve was additionally scanned using several vertical and horizontal scans.. C-scan SD-OCT were acquired using the Macular Cube 512 x 128 to create the en face image. Standard automated perimetry 24-2 tests were performed on all patients. Thirty-eight eyes of 20 pediatric patients with TDS syndrome were enrolled during this 24-months clinical trial. Their mean age was 10.9 ± 2.7 years (range 7-15 years), 12 (60%) were male and eight (40%) were female. The OCT images of the optic discs showed a protrusion of the upper edge of Bruch's membrane and choroid at the nasal edge of the optic disc in 39.5% of the eyes. The retinal nerve fiber tissue appeared to be herniated into this protrusion and bent superiorly in 15 eyes. This severe bending corresponded to early visual field anomalies that were not reduced by corrective lenses in 46.7% of the eyes. Visual field defects that do not improve by increased myopic correction in TDS may be due to the severe bending of the retinal nerve fiber tissue, which would impair axonal flow.

Stereoacuity in mild, moderate and severe glaucoma

To determine the association between stereoacuity and severity of glaucoma. Stereoacuity was measured using the Titmus stereo test for 97 glaucoma subjects with visual acuity better than 0.3 logMAR (6/12, 20/40 Snellen) and reliable Humphrey visual fields (24-2 SITA standard). The severity of visual fields was graded with the Hodapp-Anderson-Parrish (HAP) classification and visual fields index (VFI) score and the stereoacuities for different grades were compared. Presence of a significant field defect (p < 1%) in any one of the paracentral points in 10-2 SITA standard/Macular threshold was considered as a threat to fixation. Mean ± SD age of the subjects was 57.28 ± 14.0 years. The median [inter-quartile range, (IQR)] stereoacuity of the 97 subjects was 50 (40-100) arc sec with 13 subjects having stereoacuity of >3000 arc sec. Median (IQR) stereoacuity of 97 subjects classified with HAP as mild, moderate and severe were 40 (40-40), 50 (40-60) and 60 (40-400) arc sec; similarly median (IQR) stereoacuity of the subjects classified using VFI as mild, moderate and severe were 40 (40-55), 60 (40-100) and 120 (50-3000) s of arc and the difference between groups were significant (p < 0.001). Median (IQR) stereoacuity in subjects with no threat to fixation (45) and threat to fixation in at least one eye (52) were 40 (40-60) and 70 (40-800) arc sec (p < 0.001). Decreased stereoacuity was associated with greater glaucomatous visual field loss, although it was normal with early visual field defects. Relatively moderate defects can be associated with decreased stereoacuity and it is more pronounced in the severe stages of the disease when there is a threat to fixation.

Acute Zonal Occult Outer Retinopathy: Vision Loss in an Active Duty Soldier

Objective. To describe a case of acute zonal occult outer retinopathy (AZOOR) in an active duty patient. Methods. In this paper we studied fundus photographs, optical coherence tomograph, Humphrey visual field 30-2, fundus autofluorescence images, fluorescein angiograms, and electroretinography. Results. Exam findings on presentation: a 34-year-old American Indian female presented with bilateral photopsias, early RPE irregularity, and an early temporal visual field defect. Progression RPE damage and visual field defect along with ERG findings support final diagnosis of AZOOR. Conclusion. AZOOR may initially be identified as a broader category of disease called the “AZOOR complex of disorders”. Specific visual field defects, ERG results, and clinical exam findings will help distinguish AZOOR from other similar disorders.

Retinal Ganglion Cell Count Estimates Associated with Early Development of Visual Field Defects in Glaucoma

To estimate retinal ganglion cell (RGC) losses associated with the earliest development of visual field defects in glaucoma. Observational cohort study. The study group included 53 eyes of 53 patients with suspected glaucoma who were followed as part of the Diagnostic Innovations in Glaucoma (DIGS) study. These eyes had normal standard automated perimetry (SAP) visual fields at baseline and developed repeatable (3 consecutive) abnormal test results during a median follow-up of 6.7 years. An age-matched control group of 124 eyes of 124 healthy subjects recruited from the general population was included. Estimates of RGC counts were obtained using a previously published model that combines estimates of RGC numbers from SAP sensitivity thresholds and retinal nerve fiber layer (RNFL) thickness measurements with spectral domain optical coherence tomography (SD-OCT). For eyes converting to glaucoma, estimates of RGC counts were obtained at the time (within ± 3 months) of the first abnormal visual field, representing the time of earliest detection of visual field losses. Estimates of RGC counts in eyes converting to glaucoma versus healthy eyes. The average RGC count estimate in the eyes with early visual field defects was 652057 ± 115829 cells, which was significantly lower than the average of 910 584 ± 142 412 cells found in healthy eyes (P < 0.001). Compared with the average number of RGCs in the healthy group, glaucomatous eyes had an average RGC loss of 28.4%, ranging from 6% to 57%, at the time of the earliest visual field defect on SAP. Retinal ganglion cell counts performed significantly better than the SD-OCT average RNFL thickness parameter in discriminating glaucomatous from healthy eyes with receiver operating characteristic curve areas of 0.95 ± 0.02 versus 0.88 ± 0.03, respectively (P = 0.001). Glaucomatous eyes with the earliest detectable visual field loss on automated perimetry may already show substantial loss of RGCs. Empirical estimates of RGC counts combining structural and functional tests agreed closely with previous histologic reports on the number of RGCs associated with early visual fields defects on SAP.

The p53 Codon 72 PRO/PRO Genotype May Be Associated with Initial Central Visual Field Defects in Caucasians with Primary Open Angle Glaucoma

BackgroundLoss of vision in glaucoma is due to apoptotic retinal ganglion cell loss. While p53 modulates apoptosis, gene association studies between p53 variants and glaucoma have been inconsistent. In this study we evaluate the association between a p53 variant functionally known to influence apoptosis (codon 72 Pro/Arg) and the subset of primary open angle glaucoma (POAG) patients with early loss of central visual field.MethodsGenotypes for the p53 codon 72 polymorphism (Pro/Arg) were obtained for 264 POAG patients and 400 controls from the U.S. and in replication studies for 308 POAG patients and 178 controls from Australia (GIST). The glaucoma patients were divided into two groups according to location of initial visual field defect (either paracentral or peripheral). All cases and controls were Caucasian with European ancestry.ResultsThe p53-PRO/PRO genotype was more frequent in the U.S. POAG patients with early visual field defects in the paracentral regions compared with those in the peripheral regions or control group (p = 2.7×10−5). We replicated this finding in the GIST cohort (p = 7.3×10−3, and in the pooled sample (p = 6.6×10−7) and in a meta-analysis of both the US and GIST datasets (1.3×10−6, OR 2.17 (1.58–2.98 for the PRO allele).ConclusionsThese results suggest that the p53 codon 72 PRO/PRO genotype is potentially associated with early paracentral visual field defects in primary open-angle glaucoma patients.

Retinal Nerve Fiber Layer Defects in Highly Myopic Eyes with Early Glaucoma

To compare the retinal nerve fiber layer (RNFL) defects in early glaucomatous eyes between highly and non-highly myopic eyes. Sixty-one highly myopic eyes (< -6.0 diopters [D]) of 61 patients and 55 non-highly myopic eyes of 55 patients with early visual field (VF) defects were studied. The angular locations and widths of the RNFL defects were measured from red-free fundus photographs. The RNFL defect closest to the fovea was designated the "nearest RNFL defect" of each hemisphere. In total, 131 RNFL defects were found in highly myopic eyes and 82 in non-highly myopic eyes. Twenty-seven (44.3%) of the 61 highly myopic eyes, but only 8 (14.5%) of the 55 non-highly myopic eyes had their nearest RNFL defects between 0° and 10° (P < 0.001). Although the frequencies of paracentral scotomas were comparable between the two groups, the rate of inferotemporal paracentral scotomas was significantly higher in the high myopia group (P = 0.02). The numbers of nearest RNFL defects in the superior hemisphere or extending over both hemispheres were significantly higher in the high-myopia group. Multiple logistic regression analyses showed that high myopia and the nearest RNFL defect involving the papillomacular bundle were significantly associated with paracentral scotomas (odds ratio [OR]: 4.78, P < 0.05, and OR: 5.31, P < 0.001, respectively). High myopia was significantly associated with the nearest RNFL defect involving the papillomacular bundle (OR: 2.95, P < 0.05). These findings suggest that highly myopic eyes are more susceptible to papillomacular bundle damage in early glaucoma.

Diagnostic Capability of Spectral-Domain Optical Coherence Tomography for Glaucoma

To determine the diagnostic capability of spectral-domain optical coherence tomography in glaucoma patients with visual field defects. Prospective, cross-sectional study. Participants were recruited from a university hospital clinic. One eye of 85 normal subjects and 61 glaucoma patients with average visual field mean deviation of -9.61 ± 8.76 dB was selected randomly for the study. A subgroup of the glaucoma patients with early visual field defects was calculated separately. Spectralis optical coherence tomography (Heidelberg Engineering, Inc) circular scans were performed to obtain peripapillary retinal nerve fiber layer (RNFL) thicknesses. The RNFL diagnostic parameters based on the normative database were used alone or in combination for identifying glaucomatous RNFL thinning. To evaluate diagnostic performance, calculations included areas under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio. Overall RNFL thickness had the highest area under the receiver operating characteristic curve values: 0.952 for all patients and 0.895 for the early glaucoma subgroup. For all patients, the highest sensitivity (98.4%; 95% confidence interval, 96.3% to 100%) was achieved by using 2 criteria: ≥ 1 RNFL sectors being abnormal at the < 5% level and overall classification of borderline or outside normal limits, with specificities of 88.9% (95% confidence interval, 84.0% to 94.0%) and 87.1% (95% confidence interval, 81.6% to 92.5%), respectively, for these 2 criteria. Statistical parameters for evaluating the diagnostic performance of the Spectralis spectral-domain optical coherence tomography were good for early perimetric glaucoma and were excellent for moderately advanced perimetric glaucoma.

Comparison of measurement error of Cirrus HD-OCT and Heidelberg Retina Tomograph 3 in patients with early glaucomatous visual field defect

To compare the measurement error of Cirrus HD-OCT and Heidelberg Retina Tomograph 3 (HRT3) in patients with early glaucomatous visual field defect. Thirty-nine consecutive patients (39 eyes) with early glaucomatous visual field defect were included. One eye of a patient was examined with Cirrus HD-OCT and HRT3 in one session. Each instrument was used by two operators, each taking two measurements in turn. We performed measurements of average retinal nerve fiber layer (RNFL) thickness and RNFL thickness in four quadrants with Cirrus HD-OCT and 13 stereometric parameters of the optic nerve head and RNFL with HRT3. Cirrus HD-OCT parameters performed much better than HRT3 stereometric parameters. Mean (for both operators) intraoperator within-subject coefficient of variation of the best Cirrus HD-OCT parameter (average RNFL thickness) was 2.6-2.7 times lower than the best HRT3 parameters [mean cup depth and rim area (P < 0.001)]. Mean intraoperator variability of RNFL thickness in quadrants (except nasal quadrant) was also significantly lower with OCT than with HRT. The interoperator within-subject coefficients of variation for both average RNFL thickness and RNFL thickness in all quadrants were significantly lower than the interoperator variability of best HRT3 parameter [mean cup depth (P < 0.001)]. The within-subject coefficient of variation of the average/mean RNFL thickness assessed by both instruments was 5.4-7.3 times lower for Cirrus HD-OCT. Among HRT3 parameters, mean cup depth, rim area and linear cup/disk ratio were the least variable, while cup volume, cup area and cup/disc area ratio were the most variable parameters. Cirrus HD-OCT provides excellent intrasession intra- and interoperator repeatability of the RNFL measurements, especially of the average RNFL thickness in primary open-angle glaucoma (POAG) patients and POAG suspects with early glaucomatous visual field defect. The measurement error (expressed as within-subject coefficient of variation) of RNFL measurements by Cirrus HD-OCT is much lower than the error of HRT3 measurements of stereometric parameters of the optic nerve head and RNFL.

Macular and Peripapillary Retinal Nerve Fiber Layer Measurements by Spectral Domain Optical Coherence Tomography in Normal-Tension Glaucoma

To evaluate and compare the glaucoma discrimination ability of macular inner retinal layer (MIRL) thickness with that of peripapillary retinal nerve fiber layer (pRNFL) thickness measured by spectral-domain optical coherence tomography (RTVue-100; Optovue Inc, Fremont, CA) in patients with normal-tension glaucoma (NTG). Sixty-five healthy subjects and 102 with NTG were enrolled. MIRL thickness provided by a ganglion cell complex (GCC) scan and two RNFL thicknesses measured by the NHM4 (RNFL1) and RNFL 3.45 (RNFL2) modes of the RTVue-100 system were analyzed. The areas under the receiver operating characteristic curves (AUCs) of MIRL and pRNFL thicknesses for discriminating patients with NTG from control subjects were determined. The AUCs were compared between patients with central visual field (VF) defects (VF; <or=10 degrees of fixation) and peripheral VF defects (>10 degrees from fixation). The average MIRL thickness showed a strong correlation with both RNFL1 and -2 thicknesses (R(2) = 0.773, 0.774, both P < 0.0001). The AUCs for average MIRL, RNFL1, and RNFL2 thicknesses were not significantly different at 0.945, 0.973, and 0.976, respectively. However, the AUCs of the average and superior MIRL thicknesses were significantly less than that of the pRNFL thickness in eyes with moderate-to-advanced glaucoma and eyes with peripheral VF defects. The average MIRL thickness showed a strong correlation with pRNFL thickness, because patients with NTG at an early stage showed paracentral VF defects near the fixation point. MIRL thickness showed glaucoma discrimination ability comparable to that of pRNFL thickness in patients with NTG with early VF defects. In eyes with advanced or peripheral VF defect, pRNFL measurement showed a better glaucoma diagnostic ability than did MIRL measurement.