PURPOSE: To evaluate patterns of macular retinal ganglion cell (RGC) loss measured by spectral domain optical coherence tomography in patients with neurologic lesions mimicking glaucoma. METHODS: We evaluated four patients with neurological lesions who showed characteristic patterns of RGC loss, as determined by ganglion cell thickness (GCT) mapping. RESULTS: Case 1 was a 30-year-old man who had been treated with glaucoma medication. A left homonymous vertical pattern of RGC loss was observed in his GCT map and a past brain magnetic resonance imaging (MRI) revealed a hemorrhagic lesion around the right optic radiation. Case 2 was a 72-year-old man with a pituitary adenoma who had a binasal vertical pattern of RGC loss that corresponded with bitemporal hemianopsia. Case 3 was a 77-year-old man treated for suspected glaucoma. His GCT map showed a right inferior quadratic pattern of loss, indicating a right superior homonymous quadranopsia in his visual field (VF). His brain MRI revealed a left posterior cerebral artery territory infarct. Case 4 was a 38-year-old woman with an unreliable VF who was referred for suspected glaucoma. Her GCT map revealed a left homonymous vertical pattern of RGC loss, which may have been related to a previous head trauma. CONCLUSIONS: Evaluation of the patterns of macular RGC loss may be helpful in the differential diagnosis of RGC-related diseases, including glaucoma and neurologic lesions. When a patient's VF is unavailable, this method may be an effective tool for diagnosing and monitoring transneuronal retrograde degeneration-related structural changes.
Adult ; Aged ; Brain Injuries/diagnosis ; Cerebral Infarction/diagnosis ; Diagnosis, Differential ; Female ; Glaucoma/*diagnosis ; Hemianopsia/diagnosis ; Humans ; Magnetic Resonance Imaging ; Male ; Nerve Fibers/*pathology ; Nervous System Diseases/*diagnosis ; Pituitary Neoplasms/diagnosis ; Retinal Ganglion Cells/*pathology ; Retrospective Studies ; Tomography, Optical Coherence ; Tonometry, Ocular ; Visual Acuity ; Visual Field Tests ; Visual Fields

PURPOSE: To explore spatial and temporal characteristics of glaucomatous visual field (VF) progression through multi-way decomposition of data. METHODS: Six serial VF exams with intervals of 6.0 ± 1.0 months in 121 pre-perimetric glaucoma eyes and 80 perimetric glaucoma eyes were arranged into a three-dimensional cube. The data were decomposed using parallel factor analysis. RESULTS: Three tri-linear components (i.e., spatial scores, temporal loadings, and subject-specific loadings) were identified. Component 1 clearly showed differences between superior and inferior hemispheres, linear trends over time, and wide variability in perimetric glaucoma. Findings were compatible with well-known characteristics of glaucomatous VF defects. Component 2 showed nasal and central areas in contrast with superior, inferior, and temporal peripheral locations, whereas component 3 showed a contrast between nasal and temporal hemispheres. Both components 2 and 3 failed to show clear temporal trends. CONCLUSIONS: Identification of spatio-temporal patterns shows new possibilities for a multi-way decomposition methodology for earlier diagnosis and prediction of glaucomatous VF progression.
Diagnosis ; Factor Analysis, Statistical ; Glaucoma ; Visual Fields