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. 2011:5:1721-7.
doi: 10.2147/OPTH.S23204. Epub 2011 Dec 7.

Significant correlations between optic nerve head microcirculation and visual field defects and nerve fiber layer loss in glaucoma patients with myopic glaucomatous disk

Yu Yokoyama  1 , Naoko Aizawa, Naoki Chiba, Kazuko Omodaka, Masahiko Nakamura, Takaaki Otomo, Shunji Yokokura, Nobuo Fuse, Toru Nakazawa
Affiliations

Significant correlations between optic nerve head microcirculation and visual field defects and nerve fiber layer loss in glaucoma patients with myopic glaucomatous disk

Yu Yokoyama et al. Clin Ophthalmol. 2011.

Abstract

Background: Eyes with glaucoma are characterized by optic neuropathy with visual field defects in the areas corresponding to the optic disk damage. The exact cause for the glaucomatous optic neuropathy has not been determined. Myopia has been shown to be a risk factor for glaucoma. The purpose of this study was to determine whether a significant correlation existed between the microcirculation of the optic disk and the visual field defects and the retinal nerve fiber layer thickness (RNFLT) in glaucoma patients with myopic optic disks.

Methods: Sixty eyes of 60 patients with myopic disks were studied; 36 eyes with glaucoma (men:women = 19:17) and 24 eyes with no ocular diseases (men:women = 14:10). The mean deviation (MD) determined by the Humphrey field analyzer, and the peripapillary RNFLT determined by the Stratus-OCT were compared between the two groups. The ocular circulation was determined by laser speckle flowgraphy (LSFG), and the mean blur rate (MBR) was compared between the two groups. The correlations between the RNFLT and MBR of the corresponding areas of the optic disk and between MD and MBR of the optic disk in the glaucoma group were determined by simple regression analyses.

Results: The average MBR for the entire optic disk was significantly lower in the glaucoma group than that in the control group. The differences of the MBR for the tissue in the superior, inferior, and temporal quadrants of the optic disk between the two groups were significant. The MBR for the entire optic disk was significantly correlated with the MD (r = 0.58, P = 0.0002) and the average RNFLT (r = 0.53, P = 0.0008). The tissue MBR of the optic disk was significantly correlated with the RNFLT in the superior, inferior, and temporal quadrants.

Conclusions: Our study suggests that there is a causal relationship between the thinner RNFLT that led to the MD and reduction in the microcirculation in the optic nerve head.

Keywords: glaucoma; microcirculation; myopia; optic disk; optic nerve head; optic neuropathy; retinal nerve fiber layer; visual field defects.

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Figures

Figure 1
Figure 1
(A) A fundus photograph showing a typical myopia-type optic disk. The disk is oval and is tilted to the temporal side with crescent peripapillary atrophy. (B) The color-coded map of the optic nerve head. The colors in this map represent the time averages of MBR over one heartbeat. (C) The disk area was divided into the vessel area and tissue area by LSFG analyzer. The white area represents the vessel area, and the black area represents the tissue area of the optic disk. (D) The elliptical area where MBR was determined by LSFG was set at the outer edge of the myopic optic disk manually. Measurements were taken for the superior, temporal, inferior, and nasal quadrants. Abbreviations: MBR, mean blur rate; LSFG, Laser speckle flowgraphy.
Figure 2
Figure 2
Comparisons of MBR of the entire optic disk area between control and glaucoma group. The color scale bars in Figure 2A and B show the degree of MBR. The proportions of cool colors in the optic disk, which represent low MBR, are increased in the map of the glaucomatous eye rather than those of the control. (A) A color-coded map of ocular fundus of a control eye. The eyes in control group have myopic disk without glaucomatous visual field loss. (B) A color-coded map of ocular fundus in a glaucomatous eye. (C) Comparisons of MBRD between two groups. There are significant differences in these parameters between control and glaucoma groups. Notes: *Glaucoma group significantly different from control group (Mann–Whitney U test; P < 0.05) Abbreviations: MBR, mean blur rate; MBRD, average MBR over the entire optic disk.
Figure 3
Figure 3
(A) Correlation between the average retinal nerve fiber thickness (RNFLT) and the average MBR over the entire optic disk (MBRD) in myopic glaucoma patients (Y = 1.6767X + 41.844; r = 0.5324, P = 0.0008). (B) Correlation between MD of Humphrey SITA 30-2 program and MBRD in myopic glaucoma patients (Y = 0.8673X − 26.646, r = 0.5797, P = 0.0002). Abbreviations: MBR, mean blur rate; MBRD, average MBR over the entire optic disk; MD, mean deviation.
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