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. 2016 Oct:170:75-82.
doi: 10.1016/j.ajo.2016.07.020. Epub 2016 Aug 1.

Localized Changes in Retinal Nerve Fiber Layer Thickness as a Predictor of Localized Functional Change in Glaucoma

Stuart K Gardiner  1 , Brad Fortune  2 , Shaban Demirel  2
Affiliations

Localized Changes in Retinal Nerve Fiber Layer Thickness as a Predictor of Localized Functional Change in Glaucoma

Stuart K Gardiner et al. Am J Ophthalmol. 2016 Oct.

Abstract

Purpose: To determine how well rates of localized retinal nerve fiber layer thickness (RNFLT) change correlate with rates of sensitivity change at corresponding locations in the visual field in glaucoma.

Design: Retrospective cohort study.

Methods: Three hundred and sixty-four eyes of 191 participants with suspected or confirmed glaucoma, as judged by experienced clinicians, were tested every 6 months with perimetry and optical coherence tomography (OCT). For each 24-2 visual field location, the corresponding sectoral peripapillary RNFLT was defined using a 30-degree sector, centered on the angle of nerve fiber entry into the optic nerve head. Rates of change of pointwise sensitivity and sectoral RNFLT were calculated over the last 8 visits at which reliable data were obtained. Passing-Bablok regression was used to predict the rate of pointwise sensitivity change from the rate of sectoral RNFLT change, for each location.

Results: Rates of sectoral RNFLT change were significantly predictive of rates of pointwise sensitivity change at all locations in the field. Correlations were modest, averaging 0.15, ranging from 0.03 to 0.25 depending on the location. A 1 μm/y more rapid thinning in corresponding sectors was associated with 0.3 dB/y more rapid loss in the superior visual field but less than 0.1 dB/y more rapid loss at many locations in the inferior visual field.

Conclusions: Localized RNFL thinning is associated with sensitivity loss at corresponding locations in the visual field, and their rates of change are significantly correlated. Peripapillary RNFLT may be used to monitor localized changes caused by glaucoma that have measurable consequences for a patient's vision.

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Figures

Figure 1
Figure 1
For each location in the 24-2 visual field, the difference in the rate of functional change (in decibels per year) that is associated with a 1 micron per year difference in the rate of structural change in the corresponding sector, in eyes with early or suspected glaucoma. Presented in right eye orientation. Left column: functional change based on reported sensitivities. Right column: functional change after censoring sensitivities ≤15dB to equal 15dB. Top row: the predicted relation. Middle and Bottom rows: the upper and lower limits of the 95% confidence interval for this prediction. Values below 0.1 appear in blue; values above 0.2 appear in red.
Figure 2
Figure 2
The relations between the rate of functional change (in decibels per year) and the rate of structural change in the corresponding sector (in microns per year) in glaucoma patients, at two different visual field locations. The Passing-Bablok regression line is shown in each case.
See this image and copyright information in PMC

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