Partial Arcuate Research Articles

Breaking the mould: An essential need in optic neuritis management

Aims/Purpose: To present a clinical case to highlight the importance of ophthalmological examination in the management of optic neuritis.Methods: Case report.Results: A 45‐year‐old woman with Sjögren's syndrome and a family history of MS presents to the emergency department. She complains of decreased vision OD for the past 4 days, with exacerbated‐by‐eye‐movements retroocular pain and migraine‐like headache. BCVA is amaurosis OD and 1 OI, with right RAPD and no colour vision impairment in OI. Except for optic disc oedema with splinter haemorrhages in OD the rest of the ophthalmological examination is normal. RNFL‐OCT reveals thickening in the OD (220 μm/110 μm). Brain CT and laboratory tests, including D‐dimers, are normal. A LP is performed to rule out infectious causes is normal. Neurofilament and ESR are also normal. Brain and spinal MRI show no abnormalities. Due to the severity, methylprednisolone therapy is initiated. One week later, her symptoms are stable, except for headache and retroocular pain improvement. Upon reassessment, despite preserved BCVA and Ishihara in OI, an increase in RNFL thickening is noted in OI (120 μm), with partial arcuate defect in visual field. Anti‐MOG, AQP4 and a panel of autoantibodies including anti‐Ro and anti‐La, are still pending. Considering the bilateral involvement, plasma exchange therapy is initiated. 14 days after, BCVA OU has improved to 1, and the visual field and Ishihara test have normalized. RNFL thickening is still observed OU (161/120 μm) and there is persistent optic disc edema OD. Anti‐MOG are positive, AQP4‐Ab are negative, and both negative in CSF.Conclusions: The coexistence of other autoimmune diseases, can lead to attributing the ON to that disease rather than considering the neuroinflammatory aetiology, leading to delayed diagnosis. The detection of subclinical bilateral involvement was crucial in escalating the therapeutic regimen. Seropositivity is the confirmatory diagnostic marker, but in many centres, it may be difficult to obtain reliable biomarker data.

The Patterns of Visual Field Defects in Primary Angle-Closure Glaucoma Compared to High-Tension Glaucoma and Normal-Tension Glaucoma

Introduction: The aim of this study was to compare the patterns of visual field (VF) defects in primary angle-closure glaucoma (PACG) to control groups of eyes with high-tension glaucoma (HTG) and normal-tension glaucoma (NTG). Methods: Forty-eight eyes with PACG were enrolled, and control eyes with HTG and NTG matched for age, sex, and mean deviation of VF defect were selected. VF tests were performed using the 24-2 program of the Humphrey field analyzer. VF defects were classified into six patterns with the Ocular Hypertension Treatment Study classification system and were categorized into three stages (early, moderate, and advanced). Each hemifield was divided into five regions according to the Glaucoma Hemifield Test (GHT). The mean total deviation (TD) of each GHT region was calculated. Results: Compared with HTG and NTG groups, the partial arcuate VF defects were more common in the PACG group. In the PACG group, the nasal GHT region in the inferior hemifield had the worst mean TD (−8.48 ± 8.62 dB), followed by the arcuate 1 (−7.81 ± 7.91 dB), arcuate 2 (−7.46 ± 7.43 dB), paracentral (−7.19 ± 7.98 dB), and central (−5.14 ± 6.24 dB) regions; the mean TD of the central region was significantly better than those for all other regions (all p < 0.05). A similar trend was observed in the superior hemifield in the PACG group but not the VF hemifields of the HTG and NTG groups. Conclusion: Patterns of VF defect in PACG patients differ from those with HTG and NTG. This discrepancy might be due to the differences in the pathogenic mechanisms of glaucomatous optic neuropathy.

Machine-Identified Patterns of Visual Field Loss and an Association with Rapid Progression in the Ocular Hypertension Treatment Study

To identify patterns of visual field (VF) loss based on unsupervised machine learning and to identify patterns that are associated with rapid progression. Cross-sectional and longitudinal study. A total of 2231 abnormal VFs from 205 eyes of 176 Ocular Hypertension Treatment Study (OHTS) participants followed over approximately 16 years. Visual fields were assessed by an unsupervised deep archetypal analysis algorithm and an OHTS-certified VF reader to identify prevalent patterns of VF loss. Machine-identified patterns of glaucoma damage were compared against those patterns previously identified (expert-identified) in the OHTS in 2003. Based on the longitudinal VFs of each eye, VF loss patterns that were strongly associated with rapid glaucoma progression were identified. Machine-expert correspondence and type of patterns of VF loss associated with rapid progression. The average VF mean deviation (MD) at conversion to glaucoma was-2.7 decibels (dB) (standard deviation [SD]= 2.4 dB), whereas the average MD of the eyes at the last visit was-5.2 dB (SD= 5.5 dB). Fifty out of 205 eyes had MD rate of-1 dB/year or worse and were considered rapid progressors. Eighteen machine-identified patterns of VF loss were compared with expert-identified patterns, in which 13 patterns of VF loss were similar. The most prevalent expert-identified patterns included partial arcuate, paracentral, and nasal step defects, and the most prevalent machine-identified patterns included temporal wedge, partial arcuate, nasal step, and paracentral VF defects. One of the machine-identified patterns of VF loss predicted future rapid VF progression after adjustment for age, sex, and initial MD. An automated machine learning system can identify patterns of VF loss and could provide objective and reproducible nomenclature for characterizing early signs of visual defects and rapid progression in patients with glaucoma.

Prediction of Central Visual Field Severity in Glaucoma.

The severity of central visual field (VF) defects on 24-2 VF and related scotomas on 10-2 VF may be predicted by assessing perimetric defects at abnormal central 12 points on 24-2 VF in early glaucoma. Investigating the association between perimetric parameters at abnormal central 12 points on 24-2 VF and the severity of central visual field defects (CVFDs) on 24-2 VF and related parafoveal scotomas on 10-2 VF. We examined 64 eyes of 56 glaucoma patients with CVFDs on 24-2 VF with a mean deviation better than -7 dB and completed 24-2 and 10-2 VF testing within 6 months. On the basis of 10-2 VFs' pattern defects, eyes were grouped into 3: an arcuate parafoveal scotoma, severe defect; partial arcuate, moderate defect; and minimal defect. VF parameters at abnormal points (P<1%) within the central-most 4 and paracentral 8 points on total deviation/pattern deviation plots on 24-2 VF were analyzed to predict the severity of CVFDs. Eyes with arcuate scotoma showed more functional loss than eyes without arcuate scotoma on 10-2 VF (P<0.001). A significant association was observed between abnormal 24-2 VF points' (<1%) threshold sensitivity lower than 20 dB [odds ratio (OR)=7.2; P=0.002 and OR=5.1; P=0.003 for the central 4 and paracentral 8 points, respectively] and defect values worse than -15 dB (OR=8.0 and 5.6 for the central 4 and paracentral 8 points, respectively, P=0.005) with arcuate scotoma on 10-2 VF. Superior nasal defect in the central 5 degrees on 24-2 VF was significantly associated with an arcuate defect on 10-2 VF (P<0.001). Clinicians may predict the severity of CVFDs on 24-2 VF and parafoveal scotomas on 10-2 VF by measuring threshold sensitivities and defect values at abnormal central 12 points (<1%) on 24-2 VF in early glaucoma.

Classification of Visual Field Abnormalities in Highly Myopic Eyes without Pathologic Change

To develop a classification system of visual field (VF) abnormalities in highly myopic eyes with and without glaucoma. Secondary analysis of VF data from a longitudinal cohort study. One thousand eight hundred ninety-three VF tests from 1302 eyes (825 individuals). All participants underwent VF testing (Humphrey 24-2 Swedish interactive threshold algorithm standard program; Carl Zeiss Meditec) and detailed ophthalmic examination. A comprehensive set of VF defect patterns was defined via observation of the 1893 VF reports, literature review, and consensus meetings. The classification system comprised 4 major types of VF patterns, including normal type, glaucoma-like defects (paracentral defect, nasal step, partial arcuate defect, arcuate defect), high myopia-related defects (enlarged blind spot, vertical step, partial peripheral rim, nonspecific defect), and combined defects (nasal step with enlarged blind spot). A subset (n= 1000) of the VFs was used to evaluate the interobserver and intraobserver agreement and weighted κ values of the classification system by 2 trained readers. The prevalence of various VF patterns and their associated factors were determined. The classification of VF in highly myopic eyes and its associated risk factors. We found that normal type, glaucoma-like defects, high myopia-related defects, and combined defects accounted for 74.1%, 10.8%, 15.0%, and 0.1% of all unique VF tests, respectively. The interobserver and intraobserver agreements were > 89%, and the corresponding κ values were 0.86 or more between readers. Both glaucoma-like and high myopia-related VF defects were associated with older age (odds ratios [ORs], 1.07 [95% confidence interval (CI), 1.04-1.10; P < 0.001] and 1.06 [95% CI, 1.04-1.10; P < 0.001]) and longer axial length (ORs, 1.65 [95% CI, 1.32-2.07; P < 0.001] and 1.37 [95% CI, 1.11-1.68; P= 0.003]). Longer axial length showed a stronger effect on the prevalence of glaucoma-like VF defects than on the prevalence of high myopia-related VF defects (P= 0.036). We propose a new and reproducible classification system of VF abnormalities for nonpathologic high myopia. Applying a comprehensive classification system will facilitate communication and comparison of findings among studies.

Accuracy and safety of partial thickness femtosecond laser radial and arcuate keratotomy incisions in porcine eyes

BackgroundTo evaluate the accuracy and safety of micro radial and arcuate keratotomy incisions constructed by a femtosecond laser system with a curved contact patient interface in porcine eyes.MethodsPartial thickness micro radial and arcuate keratotomy incisions were constructed in porcine eyes with a femtosecond laser system and evaluated for precision of depth, quality, and consistency. Optical coherence tomography was used to determine the accuracy and precision of incision depth. Corneal endothelial safety was assessed by a fluorescent live/dead cell viability assay to demonstrate laser-induced endothelial cell loss. Quality was evaluated by ease of opening and examination of interfaces.ResultsIn two micro radial incision groups, intended incision depths of 50% and 80% resulted in mean achieved depths of 50.01% and 77.69%, respectively. In three arcuate incision groups, intended incision depths of 80%, 600 μm or 100 μm residual uncut bed thickness resulted in mean achieved depths of 80.16%, 603.03 μm and residual bed of 115 μm, respectively. No loss of endothelial cell density occurred when the residual corneal bed was maintained at a minimum of 85–116 µm. The incisions were easy to open, and interfaces were smooth.ConclusionsA femtosecond laser system with curved contact interface created precise and reproducible micro radial and arcuate keratotomy incisions. Accuracy and precision of the incision depth and preservation of endothelial cell density demonstrated the effectiveness and safety of the system.

Characteristics of Optic Disc and Visual Field Changes in Patients with Thyroid-Associated Orbitopathy and Open-Angle Glaucoma.

This study aimed to characterize the changes in the visual field (VF) patterns and disc morphology of patients with thyroid-associated orbitopathy (TAO) and open-angle glaucoma (OAG). A retrospective review of the medical records at the Tri-Service General Hospital in Taiwan identified 396 eyes of 198 patients with thyroid-associated glaucoma. A final follow-up of VF examination in 140 eyes revealed 114 eyes with VF defects, indicating disease progression. The characteristics of and changes in disc morphology, optical coherence tomography findings, and VF defects were statistically analyzed. The most common VF defects at the initial diagnosis and the end of the follow-up period were inferior partial arcuate (17%) and paracentral (15%) defects, respectively. The most common VF defect in patients with unspecific disc signs was an unspecific scotoma (13%). The most common optic disc feature was disc cupping (51%), followed by parapapillary atrophy (48%). The most frequent location of nerve fiber layer thinning was the inferotemporal region (48%). VF defects showed a significantly more pronounced progression in the non-nerve fiber bundle group than in the nerve fiber bundle group (p < 0.001). This study details the characteristics and progression of disc morphology and VF defects in patients with TAO and OAG.

Central-most Visual Field Defects in Early Glaucoma.

This study demonstrates the substantial association between visual field (VF) defect within the central-most 4 points in 24-2 VF and the VF defect exhibited by 10-2 test pattern relative to the initial defect in 24-2 VF. To evaluate the significance of central-most visual field defects (CMVFDs) in 24-2 VF in early glaucoma. This cross-sectional study examined 29 eyes of 28 glaucoma patients with CMVFDs. CMVFD was defined as a glaucomatous defect with at least 1 abnormal point at P<1% within the central 5 degrees on 3 consecutive 24-2 VF tests. 10-2 VFs were categorized into 3 groups by severity of pattern defects: deep arcuate, partial arcuate, and minimal defect. The deep arcuate group was interpreted as the most severe defect on the 10-2 VF. Mann-Whitney test was used to compare the perimetric parameters differences between 24-2 VFs with CMVFD and 10-2 VFs related to the initial defect. CMVFD was observed in 82% eyes, predominantly in the superior hemifield (86%). Arcuate-like defects (72%) on the 10-2 VF were mostly in superior hemifield (82%). The deep arcuate group showed significantly worse mean deviation (MD) and pattern standard deviation (PSD), (MD= -9.1±4, PSD =10.7±2.1 dB), than partial arcuate and minimal defect groups (all P<0.001). Eyes with deep arcuate defect had severely depressed defect depth (-26 to -35 dB) and low sensitivity (<0 to 10 dB) at abnormal points in the central 5 degrees in 24-2 VF. A significant difference among deep arcuate, partial arcuate (P<0.001), and minimal defect groups (P<0.001) was observed at abnormal points' threshold sensitivity and defect depth. Given the significance and effect of perimetric factors at abnormal test points in the central 5 degrees of 24-2 VFs, these eyes deserve attention to determine the severity of and functional impact on the CMVFD in early glaucoma by performing 10-2 test.

Arcuate foramen: "Anatomical variation shape or adaptation legacy?"

The groove of the vertebral artery on the posterior arch of the atlas (sulcus arteriae vertebralis) may become a complete or partial osseous foramen: the arcuate foramen. The presence of a complete or partial arcuate foramen is a rare anatomical variant described in a minority of patients and it seems to be associated with vertigo, vertebro-basilar insufficiency, posterior circulation strokes, and musculoskeletal pain. As the number and morphology of cervical vertebrae is highly preserved, we questioned about its significance from an evolutionary point of view. We thus investigated through an extensive literature review if the arcuate foramen is a pure anatomical variation shape or if it might represent an adaptation legacy. We observed five atlas of an extinct species, the Late Pleistocene Mammoths (M. primigenius), and we compared them with five atlas of a closely related existent species, the African elephant (L. africana). All the mammoths' atlas had an arcuate foramen through which the vertebral artery passed before turning anteriorly and becoming intradural. This foramen was not present in elephants' atlas, where only a groove was observed, such as in the majority of patients. We would like to raise the hypothesis that this peculiar morphology of mammoths' atlas might have contributed, in association with other factors, to their precocious extinction and that the arcuate foramen might represent a disadvantage in the evolutionary process, with a low prevalence in humans being the result of a natural selection.

Confirmation of G6.31+0.54 as a part of a Galactic supernova remnant

A combination of archival multi-frequency radio observations with narrow-band HAlpha optical imagery and new confirmatory optical spectroscopy have shown that candidate supernova remnant G6.31+0.54 can now be confirmed as part of a Galactic supernova remnant (SNR). It has non-thermal emission, an optical emission line spectrum displaying shock excitation and standard SNR line ratios, fine filamentary structures in HAlpha typical of optical remnants and closely overlapping radio and optical footprints. An X-ray ROSAT source 1RXS J175752.1-231105 was also found that matches the radio and optical emission though a definite association is not proven. Nevertheless, taken together, all these observed properties point to a clear SNR identification for this source. We provide a rough estimate for the kinematic distance to G6.31+0.54 of ~4.5kpc. The detected optical filaments are some ~10arcminutes in extent (or about 13 pc at the assumed distance). However, as only a partial arcuate structure of the SNR can be seen (and not a full shell) the full angular extent of the SNR is unclear. Hence the physical extent of the observed partial shell is also difficult to estimate. If we assume an approximately circular shell then a conservative fit to the optical arc shaped filaments gives an angular diameter of ~20 arcminutes corresponding to a physical diameter of ~26 pc that shows this to be an evolved remnant.

Patterns of visual field changes in thyroid eye disease

ABSTRACTThis article provides a systematic description of visual field changes in thyroid eye disease-compressive optic neuropathy (TED-CON). A retrospective, non-comparative chart review of patients with TED-CON and documented Humphrey Visual Field 24-2 or 30-2 testing was conducted with IRB approval. Ninety-six visual fields in 68 patients were classified into 7 broad categories (superior, inferior, diffuse, temporal, nasal, central/paracentral, enlarged blind spot) and 17 mutually exclusive patterns from the Ocular Hypertension Treatment Study (OHTS) or “other.” Fifty-three of 96 visual fields (55%) showed an inferior defect using the broad categories, with the remaining 6 categories ranging from 2% to 14%. The five most common OHTS patterns were other (28%), partial arcuate (28%), partial peripheral rim (9%), arcuate (8%) and altitudinal (7%). Further sub-classification showed a predominance of inferior visual field defects, ranging from 33% to 93% of each category. Of the 78 visual fields in these five categories combined, 52 (67%) were inferior defects. Inferior defect is the most typical TED-CON-associated visual field change. While the OHTS categories are geared toward classification of glaucomatous patterns, the overall predominance of inferior field defects in TED-CON was clearly demonstrated. These “other” visual field changes showing central inferior defect up to but not crossing the horizontal meridian and not contiguous from blind spot to nasal meridian should be designated as “TED-CON pattern.” The high proportion of visual fields falling under the “other” category, however, does demonstrate the need for a more specific and tailored visual field classification system for TED-CON.

Baseline visual field findings in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT).

To characterize visual field (VF) loss at the baseline visit and to evaluate VF quality control (QC) procedures in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). The Visual Field Reading Center (VFRC) evaluated 660 baseline VFs (1320 hemifields) from 165 enrolled patients. Three readers independently classified each superior and inferior hemifield and identified any abnormalities. A subset (20%) of the hemifields was reread to evaluate within- and between-reader agreements. The QC system addressed test parameters, patient data, and shipment errors. The majority (60%) of the baseline hemifields consisted of localized nerve fiber bundle-type VF loss. Approximately one-third (31.5%) of all the classifications consisted of partial arcuate defects combined with an enlarged blind spot, making this the most common type of hemifield classification. Inferior hemifield loss was greater than superior loss for both study and nonstudy eyes. Reader agreements were >90% for both inferior and superior hemifields for two out of three readers. Test-retest reliability agreement for individual readers was 95% for both hemifields. There were few QC errors with only 5.48 error points per 100-point VF. The most common type of IIHTT baseline hemifield abnormality was a localized nerve fiber bundle-like defect. Localized inferior hemifield loss was more common than superior hemifield loss. Quality control and within- and between-reader agreement were excellent for the IIHTT (ClinicalTrials.gov number, NCT01003639).

Characteristics of Undiagnosed Primary Open-Angle Glaucoma: The Tajimi Study

Purpose: To evaluate the characteristics of patients with previously undiagnosed primary open-angle glaucoma (POAG) in the Tajimi Study.Methods: Background and ophthalmic examination data from 111 patients previously undiagnosed with POAG from the Tajimi Study, a population-based survey of glaucoma, were analyzed and compared with those of eight patients with previously diagnosed glaucoma.Results: The mean deviation (MD) and vertical cup-to-disc ratio (vC/D) of the worse eye of each patient averaged −5.5 decibels (dB) and 0.72 and −10.4 dB and 0.83, respectively, in undiagnosed and diagnosed POAG. In undiagnosed POAG, arcuate and partial arcuate patterns accounted for 50% of the pattern of the visual field (VF) damage, and 95% of patients presented with intraocular pressure of 21 mmHg or less (normal tension glaucoma). The undiagnosed group had better MD and smaller vC/D values in the worse eye and less involvement of bilateral VFs than the diagnosed group (p = 0.004–0.050 with Bonferroni correction), while other factors, including mean sensitivity of the binocular VF, showed no intergroup difference.Conclusion: The characteristics of Japanese patients with previously undiagnosed POAG indicated that bilateral evaluation of the optic disc and VF are important for identifying individuals with glaucoma.

Optic Disc Pit with Peripapillary Retinoschisis Presenting as a Localized Retinal Nerve Fiber Layer Defect

A 59-year-old woman was referred to our clinic for a glaucoma evaluation. The visual acuity and intraocular pressure were normal in both eyes. However, red-free fundus photography in the left eye showed a superotemporal wedge-shaped retinal nerve fiber layer defect, and visual field testing showed a corresponding partial arcuate scotoma. In an optical coherence tomography examination, the macula was flat, but an arcuate-shaped peripapillary retinoschisis was found. Further, the retinoschisis seemed to be connected with a superotemporal optic pit shown in a disc photograph. After 3 months of a topical prostaglandin analogue medication, the intraocular pressure in the retinoschisis eye was lowered from 14 to 10 mmHg and the peripapillary retinoschisis was almost resolved. We report a rare case of an optic disc pit with peripapillary retinoschisis presenting as a localized retinal nerve fiber layer defect.

Visual Field Profile of Optic Neuritis

To evaluate visual field abnormalities after an episode of optic neuritis among participants in the Optic Neuritis Treatment Trial. Three readers independently evaluated 10 443 visual fields from 454 patients and classified visual field abnormalities into 21 different monocular categories representing 3 general types of visual loss: diffuse, localized, and artifactual. Classification frequency was determined and reader agreement was evaluated. The association of visual field abnormality classifications with mean deviation, pattern standard deviation, visual acuity, and foveal threshold was assessed. At baseline, diffuse loss accounted for 66.2% of the abnormalities in the affected eyes but only 6.2% of the abnormalities in the fellow eyes. During years 1 through 15, the affected and fellow eyes exhibited predominantly localized loss in the nerve fiber bundle region (partial arcuate, paracentral, and arcuate defects). At year 1, 35.7% of the abnormalities in the affected eyes and 34.4% in the fellow eyes consisted of localized defects. At year 15, 39.5% of abnormalities in the affected eyes and 26.3% in the fellow eyes consisted of localized defects. Foveal threshold was highly correlated with visual acuity and contrast sensitivity in the affected eye at baseline (-0.82 vs 0.79, respectively), 6 months (-0.84 vs 0.81), and 1 year (-0.84 vs 0.79). Diffuse and central loss were more predominant in the affected eye at baseline, and nerve fiber bundle defects (partial arcuate, paracentral, and arcuate) were the most predominant localized abnormalities in both the affected and fellow eyes during the study.

The Association between Glaucomatous Visual Fields and Optic Nerve Head Features in the Ocular Hypertension Treatment Study

To determine the association between change from baseline in the optic nerve head (ONH) and the visual field (VF) during follow-up of ocular hypertension participants in the Ocular Hypertension Treatment Study. Longitudinal randomized clinical trial. One hundred sixty-eight eyes of 152 ocular hypertensive participants ages 40 to 80 years. Cox hazard models were applied to 3232 eyes, which included 81 eyes that reached a study end point by developing a glaucomatous VF (VF end point) and 128 eyes that reached a study end point by developing an optic disc change (optic disc end point). Primary open-angle glaucoma end point as determined by changes in the VF or optic disc. Forty-one eyes reached an end point by both VF and optic disc criteria; 40 eyes reached only a VF end point, and 87 reached only an optic disc end point. Times to reach isolated disc or field end points were similar. Visual field end points were more likely (P<0.0001) in eyes that showed the following ONH features: an ONH hemorrhage, thinning of the optic disc rim, or enlargement of the horizontal cup-to-disc (C/D) ratio. Optic disc end points were more likely (P<0.0001) in eyes that showed the following VF features: some evidence of a nasal step or a partial arcuate VF defect, or an increase in the pattern standard deviation (PSD). Both the VF and the optic disc must be monitored with equal diligence, because either may show the first evidence of glaucomatous damage. Changes in the ONH based on stereophotographic observation (rim thinning, hemorrhage, or a slight increase in C/D ratio) and VF changes (evidence of a nasal step/partial arcuate defect or an increase in PSD) suggest that these cases have an increased risk of developing glaucoma. Confirmation of such subtle findings should be sought through repeat testing and correlation with other clinical results.

Inter-Eye Comparison of Patterns of Visual Field Loss in Patients With Glaucomatous Optic Neuropathy

To compare inter-eye patterns of visual field (VF) loss on standard automated perimetry (SAP) in patients with glaucomatous optic neuropathy. Observational cross-sectional study. Four-hundred-and-ninety eyes of 245 patients with glaucomatous optic neuropathy in at least one eye defined by masked stereophoto review were included. Patients had two reliable SAP visual fields within fifteen months for each eye. Patterns of visual field loss were classified independently by two graders masked to all other patient information. Patterns were described as altitudinal, arcuate, partial arcuate, paracentral, nasal step, temporal wedge, or normal based on the classification system of Keltner and associates. Superior and inferior hemifields were graded separately. Inter-grader agreement in visual field patterns before adjudication was 97% and 94% for the worse eye (superior and inferior hemifield) and 97% and 95% for the better eye (superior and inferior hemifield). The percentage of correspondence by hemifield location was: 53% (superior-superior), 62% (inferior-inferior), 45% (superior-inferior), and 55% (inferior-superior). The highest correspondence of individual glaucomatous VF pattern between eyes was for arcuate (superior-superior) and inferior partial arcuate (inferior-inferior) defects (24% and 26%, respectively). Smaller hemifield patterns showed lower correspondence between the eyes (nasal step, paracentral, temporal wedge, 0% to 13% correspondence). Patterns of visual field loss between eyes often corresponded within the same VF hemifield (superior-superior, inferior-inferior) as well as between opposite hemifields (inferior-superior), although opposite hemifield correspondence was less common. More advanced visual field defects (for example, partial arcuate) showed higher correspondence rates between the eyes than less advanced defects.

Relationship Between Patterns of Visual Field Loss and Retinal Nerve Fiber Layer Thickness Measurements

To investigate the association between patterns of visual field (VF) loss and retinal nerve fiber layer (RNFL) thickness measurements. Observational cross-sectional study. One hundred twenty-one glaucoma patients and 65 healthy subjects from the Diagnostic Innovations in Glaucoma Study (DIGS) were included. All glaucoma patients had repeatable abnormal VFs and scanning laser polarimetry (SLP) RNFL thickness measurements. RNFL measurements were obtained from 16 equal parapapillary sectors. Patterns of VF loss were classified as arcuate, partial arcuate, nasal step, or paracentral in each VF hemifield. Logistic regression analysis was performed to determine which RNFL sectors were associated with each VF pattern. The ability of SLP to discriminate between eyes with different VF patterns and healthy eyes using receiver operating characteristic (ROC) curve analyses also was investigated. VF patterns in the superior hemifield were significantly associated with RNFL sectors in the temporal inferior hemiretina (P < .05). ROC curve areas for discrimination between eyes with different VF patterns and healthy eyes ranged from 0.85 to 0.95. VF patterns in the inferior hemifield were most strongly associated with temporal superior RNFL sectors (P < .05). ROC curve areas for discrimination between different VF patterns and healthy eyes ranged from 0.73 to 0.98. SLP could discriminate between apparently unaffected VF hemifields in glaucoma eyes and VF hemifields in healthy eyes. Parapapillary RNFL thickness was topographically related to patterns of VF loss. SLP can differentiate between apparently unaffected VF hemifields in glaucoma eyes and normal VF hemifields in healthy eyes.