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Multicenter Study
. 2025 Jun 25;55(3):127-133.
doi: 10.4274/tjo.galenos.2025.88834.

Pattern of RNFL Damage in Early- and Late-Stage Primary Open-Angle Glaucoma Using the Disc Damage Likelihood Scale and Optical Coherence Tomography

Noor UlAin  1 , Rehan Moinuddin Shaikh  1 , Tayyaba Gul Malik  2
Affiliations
Multicenter Study

Pattern of RNFL Damage in Early- and Late-Stage Primary Open-Angle Glaucoma Using the Disc Damage Likelihood Scale and Optical Coherence Tomography

Noor UlAin et al. Turk J Ophthalmol. .

Abstract
in English, Turkish

Objectives: To determine patterns of peripapillary retinal nerve fiber layer (RNFL) damage in early- and late-stage glaucoma based on the Disc Damage Likelihood Scale (DDLS).

Materials and methods: This cross-sectional, multi-center study involved 267 eyes of 135 patients aged 18 years or older with suspected or diagnosed glaucoma. Exclusion criteria were high refractive errors, media opacities, trauma history, and systemic conditions affecting the optic disc. After a comprehensive ocular examination, the DDLS was used for glaucoma staging. Disease severity was classified into three zones: green, orange, and red. RNFL thickness was measured in four quadrants using optical coherence tomography. Patterns of RNFL damage were analyzed, especially in terms of the ISNT (inferior>superior>nasal>temporal) rule, and compared between the three groups.

Results: The male-to-female ratio was 1.59:1 and the mean age was 45.12±15.76 years. There were statistically significant differences among the groups for average, inferior, superior, and temporal RNFL thickness (p<0.00001). However, the difference in nasal RNFL was insignificant. The ISNT rule was the commonest pattern in the study participants (64.4%) and progressive loss of pattern was observed with increased disease severity.

Conclusion: This study revealed an association between disease severity and RNFL thinning in the inferior, superior, and temporal quadrants, while nasal RNFL showed no significant association with disease severity. The ISNT rule was more frequently observed in the early stages and diminished with advanced glaucoma. These results highlight RNFL thinning based on the DDLS as an important marker for glaucoma monitoring.

Amaç: Disk Hasarı Olasılığı Ölçeği’ne (DHOÖ) göre erken ve geç evre glokomda peripapiller retina sinir lifi tabakası (RSLT) hasarı paternlerini belirlemek.

Gereç ve yöntem: Bu kesitsel, çok merkezli çalışmaya, glokom şüphesi veya tanısı olan 18 yaş ve üstü 135 hastanın 267 gözü dahil edilmiştir. Dışlama kriterleri ileri refraksiyon kusuru, medya opasitesi, travma öyküsü ve optik diski etkileyen sistemik hastalıklar olarak belirlendi. Kapsamlı bir oküler muayeneden sonra glokom evrelemesi için DHOÖ kullanıldı. Hastalık şiddeti yeşil, turuncu ve kırmızı olmak üzere üç bölgeye ayrıldı. RSLT kalınlığı optik koherens tomografi kullanılarak dört kadranda ölçüldü. RSLT hasarı paternleri, özellikle ISNT kuralına (inferior>superior>nazal>temporal) göre analiz edildi ve üç grup arasında karşılaştırıldı.

Bulgular: Erkek/kadın oranı 1,59:1 ve ortalama yaş 45,12±15,76 yıl idi. Gruplar arasında ortalama, inferior, superior ve temporal RSLT kalınlığı açısından istatistiksel olarak anlamlı fark saptandı (p<0,00001). Ancak, nazal RSLT’deki fark anlamlı değildi. ISNT kuralı, çalışmaya dahil edilen katılımcılarda en yaygın (%64,4) izlenen paterndi ve hastalık şiddetinin artmasıyla birlikte progresif patern kaybı gözlendi.

Sonuç: Bu çalışmada, inferior, superior ve temporal kadranlarda hastalık şiddeti ile RSLT incelmesi arasında bir ilişki olduğu bulunurken, nazal RSLT hastalık şiddeti ile anlamlı bir ilişki göstermemiştir. ISNT kuralı erken evrelerde daha sık gözlendi ve ileri glokomda azaldı. Bu sonuçlar, glokom takibinde DHOÖ’ye göre RSLT incelmesinin önemli bir belirteç olduğuna işaret etmektedir.

Keywords: Disc Damage Likelihood Scale; Primary open-angle glaucoma; retinal nerve fiber layer.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Grading of disease based on the Disc Damage Likelihood Scale. Adapted from Spaeth and Paulus,7 2010. Image available through Creative Commons Attribution-NonCommercial-NoDerivs 3.0
See this image and copyright information in PMC

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