To know the pattern of visual field (VF) defect of low tension glaucoma (LTG), its diffuse and localized VF defects were compared using the significance values (p-value) of mean deviation (MD) and corrected pattern standard deviation (CPSD), which are calculated with STATPAC in Humphrey Visual Field Analyser. Sixteen eyes of LTG were enrolled and 34 eyes of primary open angle glaucoma (POAG) were used as controls. The degree of VF defects in LTG and POAG was relatively mild with the p-value of MD equal to or greater than 1%. Neither mean MD nor mean CPSD of LTG was significantly different from each of POAG (p > 0.8 and p > 0.2, respectively). Comparing the p-values of MD and CPSD, many patients showed more significant p-value of MD in LTG and POAG (62.5% and 61.8%, respectively). However, relatively more severe defect of CPSD tended to occur more frequently in LTG than in POAG (25% and 5.9%, respectively, chi-square = 4.964, p < 0.09). The relation between p-values of MD and CPSD was not significantly influenced by the intraocular pressure, MD or vertical cup to disc ratio in either LTG or POAG.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Glaucoma, Open-Angle/*pathology/physiopathology ; Humans ; *Intraocular Pressure ; Male ; Middle Aged ; Optic Disk/*pathology ; Probability ; Vision Disorders/*pathology ; *Visual Fields

A 32-year-old man with blurred vision in the right eye and headache presented with anterior uveitis, an intraocular pressure (IOP) of 60 mmHg, an open angle, no visual field defects, and normal optic nerve. He had a history of five previous similar attacks. In each of the previous instances, his anterior uveitis and high IOP were controlled with antiglaucoma medications and topical steroids. However, at the fifth attack, his optic disc was pale and a superior paracentral visual field defect was shown. Brain magnetic resonance image studies were normal. This case represents that a recurrent Posner-Schlossman syndrome (PSS)-induced optic disc atrophy likely due to ocular ischemia caused by a recurrent, high IOP. Although PSS is a self-limiting syndrome, we should manage high IOP and prevent ischemia of the optic nerve head by treating with ocular antihypertensive medications.
Atrophy/diagnosis/etiology ; Diagnosis, Differential ; Glaucoma, Open-Angle/*complications/diagnosis/physiopathology ; Humans ; *Intraocular Pressure ; Male ; Optic Disk/*pathology ; Optic Nerve Diseases/diagnosis/*etiology/physiopathology ; Syndrome ; Young Adult

PURPOSE: To evaluate the relationship between the structural damage as assessed by time-domain optical coherence tomography (OCT) and functional changes in glaucoma. METHODS: In total, 190 patients with normal tension glaucoma or primary open angle glaucoma were included in this study. The thickness of retinal nerve fiber layer (RNFL) around the optic disc and the area of RNFL defect were determined using OCT scans. The relationships between the RNFL thickness or area of the defect and visual field (VF) indices were assessed using the Lowess function, regression analysis and partial Spearman correlation. The differences between these associations depending on the stage of VF damage were further analyzed. Age, optic disc size, refraction, central corneal thickness and the presence of systemic disease were corrected for in order to exclude confounding factors. RESULTS: A logarithmic scale of RNFL thickness showed a negative linear relationship with VF indices. The area of the RNFL defect showed a weak correlation with the pattern of standard deviation, whereas the remnant RNFL thickness was moderately correlated with the pattern of standard deviation (partial Spearman correlation coefficient, 0.39, -0.47, respectively; p < 0.0001). Many outliers were detected in the Lowess-plotted graphs. Multiplication of the area and the inverted RNFL thickness showed a moderately correlated logarithmic relationship with the VF indices (partial Spearman correlation coefficient, 0.46; 95% confidence interval, 0.34 to 0.57; p < 0.0001). In the severe stage of VF damage, correlation between the area of the RNFL defect and mean deviation was significantly greater than in other stages (partial Spearman correlation coefficient, -0.66; p = 0.02). CONCLUSIONS: The thickness of the RNFL had a negative logarithmic correlation with the VF indices and was more relevant to the VF indices than the area of the RNFL defect, as measured by OCT.
Aged ; Female ; Glaucoma, Open-Angle/*physiopathology ; Humans ; Low Tension Glaucoma/*physiopathology ; Male ; Middle Aged ; Nerve Fibers/*pathology ; Optic Nerve Diseases/*physiopathology ; Retinal Ganglion Cells/*pathology ; Tomography, Optical Coherence ; Visual Field Tests ; Visual Fields/*physiology

To investigate the correlation between optic nerve head configuration and visual field defects, optie nerve head analysis using confocal scanning laser tomography (Heidelberg Retina Tomograph, HRT) and automated static threshold perimetry using a Humphrey Field Analyzer (program C3O-2) were performed on 81 eyes of 44 primary open-angle glaucoma (POAG) patients. The optic nerve head parameters-rim area, rim volume, mean retinal nerve fiber layer thickness, height variation contour, and third moment in contour were measured by HRT and were analyzed for correlation with visual field indices-mean deviation, and corrected pattern standard deviation. All optic nerve hend parameters except HVC correlated significantly with the visual field indices; the highest correlation was between rim area and mean deviation (r = 0.6172, p < 0.O0001). The rim area of the superior and inferior quadrants correlated significantly with the visual field defects in corresponding sectors. Structural optic disc measurements by HRT correlated significantly with funetional optic nerve head damage in POAG
Female ; Glaucoma, Open-Angle/*pathology/physiopathology ; Humans ; Male ; Middle Aged ; Nerve Fibers/pathology ; Optic Disk/*pathology/physiopathology ; Retina/pathology ; Tomography/*methods ; Vision Disorders/*pathology/physiopathology ; Visual Field Tests ; *Visual Fields

The aim of this study was to determine the relationship between the frequency doubling technology (FDT) screening algorithm and parapapillary retinal nerve fiber layer (RNFL) thickness in the eyes of glaucoma suspects and patients with open angle glaucoma. FDT C20-1 screening program and a scanning laser polarimetry (SLP) system (GDx-NFA) was used to assess 53 glaucomatous eyes, 53 glaucoma suspects and 36 normal control eyes. In glaucomatous eyes, there were correlations between the FDT the screening algorithm and RNFL retardation values in several polarimetric indices, most significantly "inferior thickness" (r = -0.321, P = 0.029). In the eyes of glaucoma suspects, however, we observed no correlation between the FDT results and RNFL retardation values (r = 0.080, P > 0.05, "inferior thickness"). In glaucomatous eyes, the abnormal scores obtained with FDT screening program correlated negatively with RNFL retardation values, as measured by SLP. Despite poor correlation between the FDT abnormal score and RNFL retardation value in glaucoma suspects, detection of abnormality using the FDT screening protocol may aid in the assessment of early glaucomatous structural damage.
Comparative Study ; Glaucoma, Open-Angle/*diagnosis/physiopathology ; Humans ; Intraocular Pressure ; Lasers/diagnostic use ; Microscopy, Confocal ; Middle Aged ; Nerve Fibers/*pathology ; Ocular Hypertension/diagnosis/physiopathology ; Optic Nerve/*pathology ; Perimetry/*methods ; Retinal Ganglion Cells/*pathology

In the early stages of glaucoma, the disc changes prior to visual field loss, so assessment of the optic disc is very important for the evaluation of the glaucoma patient. The aim of this study is to assess the glaucomatous disc and to look for the features of the optic disc that are commonly associated with early visual field loss. Forty-three eyes of 28 patients were included in this investigation. The criteria for inclusion were a cup/disc(C/D) ratio of more than 0.4 by direct ophthalmoscopy, no visual field defect with Goldmann perimetry, and open anterior chamber angle. Each optic disc was photographed with a Canon fundus camera with Polaroid 600 Plus film. Each photographic set was then examined stereoscopically for morphologic parameters: 1) comparison of vertical versus horizontal C/D ratio; 2) presence of nasal cupping; 3) presence of overpassing vessels; 4) presence of baring of circumlinear vessels; 5) presence of peripapillary atrophy; 6) ratio of the thinnest neuroretinal rim(NRR) width in the vertical sectors of the NRR width of the temporal sector. All subject's central visual fields were examined with an automated static perimeter, Humphrey program C30-2 with STATPAC. The C/D ratio estimated by direct ophthalmoscopy consistently showed a smaller C/D ratio than that found by the stereophotographic method. The parameter with the highest probability value to differentiate between the optic disc of the early visual field loss and the optic disc of normal subjects was "Ratio of the thinnest NRR width in the vertical sectors to the NRR width of the temporal sector < or = 85%". Although it has less resolving power than slide film, a stereo disc photograph with Polaroid film is a quick and simple method of recording changes, and the ratio of the thinnest NRR width in the vertical sectors to the temporal sector is a good predictive parameter for detection of early visual field loss.
Adolescent ; Adult ; Aged ; Child ; Female ; Fundus Oculi ; Glaucoma, Open-Angle/*pathology/physiopathology ; Humans ; Male ; Middle Aged ; Ocular Hypertension/*pathology/physiopathology ; Optic Disk/*pathology ; Photography ; Visual Field Tests ; *Visual Fields

OBJECTIVETo explore the relationship between neuroretinal rim area (RA) /retinal nerve fiber layer (RNFL) thickness and differential light sensitivity (DLS) in visual field in primary open angle glaucoma (POAG).

METHODSFifty-one eyes of 51 patients with POAG were examined with HRT II, GDx VCC, and Octopus 101 for RA, RNFL thickness, and DLS. Their correlations were evaluated with linear and logarithmic regression models globally and for individual sectors.

RESULTSIn all the considered patients, visual field DLS was significantly correlated with neuroretinal RA or RNFL thickness globally and in individual sectors. Logarithmic fits were significantly better than linear fits for the global data and in most sectors. In preperimetric glaucoma, such correlations were weak and linear (R2 = 0.01-0.26). However, in perimetric glaucoma, the correlations were much stronger and curvilinear model gave the better fit (R2 = 0.15-0.84). Neuroretinal RA and RNFL thickness were linearly correlated.

CONCLUSIONNeuroretinal RA, RNFL thickness, and DLS in visual field were well correlated in POAG.

Adult ; Aged ; Aged, 80 and over ; Female ; Glaucoma, Open-Angle ; pathology ; physiopathology ; Humans ; Male ; Middle Aged ; Nerve Fibers ; pathology ; Optic Disk ; pathology ; Photophobia ; etiology ; Regression Analysis ; Retina ; pathology ; Visual Fields ; physiology ; Young Adult

PURPOSE: To compare quantitative polarimetric measurements in eyes with NTG and HTG using GDx-VCC. Both groups were matched by age and glaucoma stage based on the Humphrey visual field test. METHODS: We retrospectively reviewed the records of 146 patients who underwent Humphrey field analysis (HFA) and GDx-VCC. We compared outcomes of retinal nerve fiber layer (RNFL) parameters among the three groups by ANOVA and between each pair of groups using the Tukey-Kramer Post-Hoc test. We also evaluated the sensitivity and specificity of GDx-VCC in detecting glaucoma in each group. RESULTS: The mean age and HFA mean deviation (MD) were 55.6+/-9.5 years and -0.8+/-1.5 dB in 47 control patients, 59.4+/-9.0 years and -5.77+/-4.38 dB in 49 NTG patients, and 59.4+/-11.7 years and -8.09+/-6.77 dB in 51 HTG patients, respectively. All thickness parameters were lower in HTG patients compared to NTG patients, but there were no significant differences in ratio parameters between age-matched early HTG and NTG patients. The sensitivity of GDx-VCC was significantly higher in both early and total HTG patients compared to the respective groups of NTG patients. CONCLUSIONS: Compared to eyes with NTG, eyes with HTG showed reduced RNFL thickness and ratio parameters when patients were age and visual field matched. GDx-VCC appeared to be more sensitive in detecting RNFL damage in HTG patients.
Visual Fields ; Severity of Illness Index ; Retrospective Studies ; Retinal Ganglion Cells/*pathology ; Perimetry/*methods ; Nerve Fibers/*pathology ; Middle Aged ; Lasers/*diagnostic use ; Intraocular Pressure/*physiology ; Humans ; Glaucoma, Open-Angle/*pathology/physiopathology ; Follow-Up Studies ; Aged

PURPOSE: To compare the clinical characteristics of unilaterally progressing glaucoma (UPG) and simultaneously bilaterally progressing glaucoma (BPG) in medically treated cases. METHODS: Primary open angle glaucoma patients were classified as having UPG or BPG according to an assessment of optic disc and retinal nerve fiber layer photographs and visual field analysis. Risk factors including the presence of systemic diseases (hypertension, diabetes, cerebrovascular accident, migraine, and dyslipidema) were compared between the UPG and BPG groups. Baseline characteristics and pre- and post-treatment intraocular pressure (IOP) were compared between the progressing eye (PE) and the non-progressing eye (NPE) within the same patient in the UPG group and between the faster progressing eye and the slower progressing eye in the BPG group. RESULTS: Among 343 patients (average follow-up period of 4.2 years), 43 were categorized into the UPG group and 31 into the BPG group. The prevalence of all analyzed systemic diseases did not differ between the two groups. PEs in the UPG group had more severe pathology in terms of baseline visual field parameters than NPEs (mean deviation -6.9 ± 5.7 vs. -2.9 ± 3.9 dB, respectively; p < 0.001). However, baseline IOP, mean follow-up IOP, and other clinical characteristics were not significantly different between the PE and the NPE in the UPG group. The progression rate was significantly higher in the faster progressing eye in patients with BPG than in the PE for patients with UPG (-3.43 ± 3.27 vs. -0.70 ± 1.26 dB/yr, respectively; p = 0.014). CONCLUSIONS: There were no significant differences in the prevalence of systemic diseases between the UPG and BPG groups. Simultaneously bilaterally progressing patients showed much faster progression rates than those with a unilaterally progressing eye.
Disease Progression ; Female ; Follow-Up Studies ; Glaucoma, Open-Angle/*diagnosis/physiopathology ; Humans ; Intraocular Pressure/*physiology ; Male ; Middle Aged ; Optic Disk/*pathology ; Retina/*pathology ; Retrospective Studies ; Time Factors ; Visual Fields/*physiology

PURPOSE: To document the clinical features of disc hemorrhage in patients with branch retinal vein occlusion (BRVO) and normal tension glaucoma (NTG), and to evaluate the relationship between BRVO and NTG with disc hemorrhages. METHODS: From July 2001 to May 2006, sixteen patients with both NTG and BRVO in different eyes were successively collected from outpatient population of Seoul National University Hospital in this observational case series. The frequency and location of disc hemorrhages, history of associated systemic diseases, and the order of the time of diagnosis between NTG and BRVO were studied. RESULTS: All patients had unilateral BRVO, and their mean age was 63.3+/-10.6 years. Disc hemorrhages were detected in eight patients (50%) during the mean follow-up of 26.8 months (range, 3-96 months). Six patients (75%) had disc hemorrhages in the non-BRVO eyes and two patients (25%) in BRVO eyes. Five hemorrhages (62.5%) were located at inferior-temporal quadrant of the optic disc. History of systemic hypertension was identified in 12 patients (75.0%). In 11 patients (68.8%), NTG was diagnosed at the same time as BRVO. CONCLUSIONS: A higher frequency of disc hemorrhages was identified in patients with both BRVO and NTG. Therefore, some cases of NTG, especially with disc hemorrhages, may share a common vascular pathophysiology with BRVO.
Adult ; Aged ; Eye Hemorrhage/*etiology/pathology/physiopathology ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Glaucoma, Open-Angle/*complications/pathology/physiopathology ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Optic Disk/*pathology ; Optic Nerve Diseases/*etiology/pathology/physiopathology ; Retinal Vein Occlusion/*complications/pathology ; Retrospective Studies ; Severity of Illness Index ; Visual Acuity