Clinical Course of the Eyes with Retinal Nerve Fiber Layer Defect and Normal Visual Field

ABSTRACT

PURPOSE: To investigate the clinical course of eye with retinal nerve fiber layer (RNFL) defect without visual field (VF) defect, and to assess the risk factors for the progression of RNFL defect and the development of VF defect. METHODS: We performed retrospective chart review of the patients who had had RNFL photography and Humphrey visual field test. The seventy six eyes of 76 patients showed RNFL defect with normal VF. RESULTS: The average follow-up period was 36.6 months. Among the 76 eyes, 64 eyes (84%) showed neither the progression of RNFL defect nor the development of VF defect. Six eyes (8%) showed progression of RNFL defect without VF deterioration and 4 eyes (5%) showed development of VF defect without progression of RNFL defect. Two eyes (3%) showed both progression of RNFL defect and development of VF defect. The progression of RNFL defect was significantly related to the disc hemorrhage and the number of anti-glaucoma medications and less significantly to intraocular pressure (IOP) fluctuation (p=0.051). The development of VF defect was related to the number of anti-glaucoma medications. CONCLUSIONS: The majority (84%) of eyes with RNFL defect but normal VF did not show any sign of glaucomatous progression for average 36.6 months. The VF defect developed in 8% and the RNFL defect progressed in 11%. The factors related to progression of RNFL defect were the disc hemorrhage, the number of anti-glaucoma medications and IOP fluctuation. The factors related to the development of VF defect was the number of anti-glaucoma medications.