Structural and vascular changes in glaucoma with single-hemifield defect: predictors of opposite hemifield visual field progression.

PURPOSE: To investigate longitudinal changes in optic nerve head (ONH) superficial vessel density (VD), macular VD, circumpapillary retinal nerve fiber layer (RNFL) thickness, and macular ganglion cell-inner plexiform layer (GCIPL) thickness, and their associations with future VF defects in unaffected hemifields of primary open angle glaucoma (POAG) eyes with baseline VF defect confined to a single hemifield. METHODS: This retrospective observational study included 61 POAG eyes with VF defect confined to a single hemifield monitored over a mean follow-up time of 2.7 years. Development of VF defect in opposite hemifield was defined based the Early Manifest Glaucoma Trail criteria. Each eye was classified into either "conversion" or "no conversion" groups according to development of VF defect in the unaffected hemifield. The rates of longitudinal changes in VD and structure parameters in each hemiretina were compared between the two groups. A Cox proportional hazard model was used to identify potential risk factors for VF conversion in the unaffected hemifield. RESULTS: Among 61 eyes, 17 eyes (27.9%) were classified as "conversion" and 44 eyes (72.1%) were classified as "non-conversion" groups. The conversion group exhibited significantly greater rates of both VD and structural changes in both hemiretinas. In Cox proportional hazard model, greater rate of change in GCIPL thickness, ONH superficial VD, and macular VD of both hemiretinas and greater rate of change in RNFL thickness of the unaffected hemiretina were identified as risk factors for VF conversion in the unaffected hemifield. CONCLUSIONS: Monitoring progressive changes in VD and structural parameters effectively predict future VF defect in the opposite hemifields of POAG eyes with single-hemifield defects.

Effect of internal limiting membrane peeling on visual field sensitivity in eyes with epiretinal membrane accompanied by glaucoma with hemifield defect and myopia.

PURPOSE: To investigate the effects of internal limiting membrane (ILM) peeling on visual field sensitivities in eyes with epiretinal membrane (ERM) accompanied by glaucoma with hemifield defect and myopia. STUDY DESIGN: Retrospective clinical study METHODS: We reviewed clinical records of patients with ERM who underwent vitrectomy and ERM/ILM peeling. We first collected clinical data of eyes with ERM and glaucoma with hemifield defect. We recorded visual field sensitivities at 52 points and analyzed differences between before and after surgery. We then compared the changes in visual field sensitivity between glaucomatous and normal hemifields. Next, we collected ERM eyes without glaucoma and stratified them into two groups based on axial length (threshold = 26.0 mm). In these eyes, we also recorded visual field sensitivities at 52 points and analyzed differences between before and after surgery. RESULTS: The study included 18 eyes with ERM and glaucoma with hemifield defect (11 men; mean age, 68.3 ± 7.2 years). These eyes showed significant sensitivity reductions at 5/26 points, mainly in the nasal area of the glaucomatous hemifield, whereas only 1/26 points exhibited significant sensitivity reduction in the normal hemifield. In eyes with axial length <26.0 mm and axial length ≥26.0 mm, 29 peripheral and seven superior peripheral points showed significant improvements in visual field sensitivities, respectively. CONCLUSION: Visual field sensitivity reduction occurred mainly in the nasal region of the glaucomatous hemifield. Differences in axial length alone were not a prominent risk factor for reduced visual field sensitivity after ILM peeling in eyes with ERM.

Macular vessel density in untreated normal tension glaucoma with a hemifield defect.

PURPOSE: To investigate macular vessel density (MVD) and structural alterations in untreated normal tension glaucoma (NTG) with a hemifield defect (HFD) and to compare these with the findings in healthy eyes. STUDY DESIGN: Case series with a healthy group for comparison. METHODS: Thirty-four eyes of 34 untreated NTG patients with HFD and 28 eyes of 28 healthy subjects were enrolled. RTVue-XR AvantiTM (Optovue, Inc.), a combined OCT-A and SD-OCT system, was used to determine MVD and inner macular thickness (IMT) measurements. Mean circumpapillary retinal nerve fiber (cpRNFL) and macular ganglion cell complex (mGCC) thicknesses were measured with the RTVue-100TM (Optovue, Inc.). Wilcoxon signed-rank test was used to evaluate differences between defective and normal hemifields in NTG eyes and Mann-Whitney U test to evaluate differences between normal hemifields in NTG eyes and healthy eyes. RESULTS: In comparison with healthy eyes, the normal hemifields of NTG eyes showed significantly reduced MVD, as well as cpRNFL and mGCC thicknesses, although IMT did not differ between the two groups. The defective hemifield in NTG eyes showed significantly reduced IMT, as well as cpRNFL and mGCC thicknesses, compared with the normal hemifield, although MVD did not differ between the two hemifields. CONCLUSION: Hemodynamic deficiencies and structural damage might have already begun in the perimetrically normal hemifields of NTG eyes. Further studies are needed to elucidate whether the reduction in MVD may precede structural changes or the reduction in vasculature and structural loss may vary with disease severity in at least in some cases.

RNFL and Ganglion Cell Complex Thickness in Normal Hemifield According to the Severity of Glaucoma

PURPOSE: To analyze the thickness of the circumpapillary retinal nerve fiber layer (cRNFL) and macular ganglion cell complex (mGCC) in apparently normal hemifield areas of glaucomatous eyes with superior or inferior visual hemifield defects according to their severity compared with the same hemifield of normal eyes using Topcon 3D spectral-domain optical coherence tomography (SD-OCT). METHODS: The present study included 90 normal eyes and 90 glaucomatous eyes with superior or inferior visual hemifield defects that underwent cRNFL and mGCC imaging using 3D SD-OCT. The cRNFL and mGCC parameters were compared between normal hemifield in glaucomatous eyes and the same hemifield in normal eyes. The mean deviation (MD) parameters (Mild: MD > -6 dB, 54 eyes; Moderate: -6 dB ≥ MD ≥ -12 dB, 60 eyes; Severe: MD < -12 dB, 30 eyes) in glaucomatous eyes were also compared between the 3 severity groups. RESULTS: The average hemifield cRNFL thickness was 93.6 ± 24.2 µm and 118.1 ± 14.1 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 107.8 ± 19.1 µm and 124.9 ± 17.1 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively. mGCC thickness was 95.8 ± 5.9 µm and 103.5 ± 7.7 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 93.4 ± 8.2 µm and 104.5 ± 8.2 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively (all p < 0.05). The thickness parameters were decreased in normal hemifield of glaucomatous eyes, which significantly decreased according to the severity (MD) of visual field defect (all p < 0.01). CONCLUSIONS: The measurement of cRNFL and mGCC thickness in normal hemifield of glaucomatous eyes using SD-OCT is useful in detecting structural glaucomatous changes before visual field defects appear.

RNFL and Ganglion Cell Complex Thickness in Normal Hemifield According to the Severity of Glaucoma

PURPOSE: To analyze the thickness of the circumpapillary retinal nerve fiber layer (cRNFL) and macular ganglion cell complex (mGCC) in apparently normal hemifield areas of glaucomatous eyes with superior or inferior visual hemifield defects according to their severity compared with the same hemifield of normal eyes using Topcon 3D spectral-domain optical coherence tomography (SD-OCT). METHODS: The present study included 90 normal eyes and 90 glaucomatous eyes with superior or inferior visual hemifield defects that underwent cRNFL and mGCC imaging using 3D SD-OCT. The cRNFL and mGCC parameters were compared between normal hemifield in glaucomatous eyes and the same hemifield in normal eyes. The mean deviation (MD) parameters (Mild: MD > -6 dB, 54 eyes; Moderate: -6 dB ≥ MD ≥ -12 dB, 60 eyes; Severe: MD < -12 dB, 30 eyes) in glaucomatous eyes were also compared between the 3 severity groups. RESULTS: The average hemifield cRNFL thickness was 93.6 ± 24.2 µm and 118.1 ± 14.1 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 107.8 ± 19.1 µm and 124.9 ± 17.1 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively. mGCC thickness was 95.8 ± 5.9 µm and 103.5 ± 7.7 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 93.4 ± 8.2 µm and 104.5 ± 8.2 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively (all p < 0.05). The thickness parameters were decreased in normal hemifield of glaucomatous eyes, which significantly decreased according to the severity (MD) of visual field defect (all p < 0.01). CONCLUSIONS: The measurement of cRNFL and mGCC thickness in normal hemifield of glaucomatous eyes using SD-OCT is useful in detecting structural glaucomatous changes before visual field defects appear.

Difference in the properties of retinal nerve fiber layer defect between superior and inferior visual field loss in glaucoma.

PURPOSE: To investigate the patterns of retinal nerve fiber layer (RNFL) defects in mean deviation-matched early glaucomatous eyes with either superior or inferior visual hemifield loss. METHODS: Seventy-five open-angle glaucoma patients with isolated parafoveal scotoma (PFS) within a central 10° of fixation, and 62 patients with isolated peripheral nasal scotoma (PNS) in the nasal periphery outside 10° of fixation were enrolled if the scotoma involved only one hemifield. The relationship between the mean threshold sensitivity (MS) of each corresponding VF sector and optical coherence tomography-measured RNFL thickness was assessed by logarithmic regression analysis. The angular widths and locations of the RNFL defects were measured from red-free fundus photographs. RESULTS: Eyes with superior PFS showed a significant relationship between RNFL thickness and corresponding MS at clock-hours 7 and 8 while eyes with inferior PFS had significant relationship at clock-hours 9, 10, and 11. Eyes with superior PNS displayed a significant relationship between RNFL thickness and MS at clock-hour 7 while eyes with inferior PNS showed significant relationship at clock-hours 11 and 12. Overall, fundus photographs-measured RNFL defect associated with inferior hemifield loss (inferior PFS + PNS) was significantly wider and closer to the horizontal meridian than those with superior hemifield loss (superior PFS + PNS) (P = 0.032 and 0.009, angular width and location, respectively). CONCLUSIONS: A superior RNFL defect associated with inferior hemifield loss was wider and was located closer to the horizontal meridian of the optic disc than an inferior defect with superior field loss, particularly in patients with central VF loss.