Characteristics Of Visual Field And Retinal Nerve Fiber Layer Defect In Advanced Glaucoma

Characteristics of Visual field defect in advanced glaucomaPurpose:To study the clinical features of visual field defect in advanced glaucoma.Methods:A retrospective non-controlled study.357 patients of primary open angle glaucoma,acute primary angle-closure glaucoma and chronic primary angle-closure glaucoma were enrolled and interviewed in our hospital between 2003 to 2008. Patients with the central 5-10 degrees of visual field or the temporal peripheral field were screened from glaucomatous visual field data.Then the shape and the distribution were analyzed.In addition,we calculated the ratio of each distribution in advanced glaucomatous visual field defects.Statistical analysis of single-factor and multivariate conditional logistic regression were performed to screen the relationship between the remaining visual field and the risk factors such as age,gender,type of glaucoma and IOP rise,high myopia,diabetes,hypertension and so on.Results:33.9%of the patients were central 5-10 degrees of visual field,66.1%of the patients were temporal peripheral field.Among the patients with central 5-10 degrees of visual field,66.1%hadn't affected visual acuity,while 33.9%of the patients did have.The patients with temporal peripheral field always progressed to a visual acuity of 20/200 or worse.Among the latter,it could be found 9.7%in superior field,23.3% in the inferior and 66.9%across the horizontal meridian.During statistical analysis of single-factor and multivariate conditional logistic regression,the type of the IOP rise and glaucoma has a positive correlation with the remaining visual field.Conclusions:Visual field defect in advanced glaucoma has different shapes and distributions.The type of the IOP rise and glaucoma has a positive correlation with the remaining visual field. Purpose:To correlate structure of retinal nerve fiber layer with function in advanced glaucoma.Methods:Average RNFL thickness and RNFL thickness in four quadrants and in 16 sections were measured using fourier-domain optical coherence tomography(fdOCT). 16sections were ST2(Superior Temporal),SN2(Superior Nasal),IT2(Inferior Temporal),IN2(Inferior Nasal),TU2(Temporal Upper),TL2(Temporal Lower), NU2(Nasal Upper),NL2(Nasal Lower).Results:16 patients with central 5-10 degrees of visual field and 16 with temporal peripheral field were enrolled into the study.The remaining retinal nerve fiber layer measured in all patients were:average 61.30±7.67μm,superior quadrant 78.05±9.66μm, inferior quadrant 80.02±11.91μm,nasal quadrant 44.54±9.44μm,temporal quadrant 42.60±9.68μm,the differences of RNFL thickness between normal and patients were significant(P＜0.05).The average retinal nerve fiber layer measured in patients with central 5-10 degrees of visual field and temporal peripheral field were(60.99±8.20) um,(61.52±7.54)μm respectively.There was no statistically significant difference in RNFL thickness between the two groups(P＞0.05).In the eyes with central 5-10 degrees of visual field,temporal quadrant and 3 sections(TU₁,TU₂,TL₂) thickness were higher than the other group.In the eyes with temporal peripheral field,nasal quadrant and 4 sections(SN₂,NU₂,NU₁,NL₁) thickness were higher than the other group.And the differences were statistically significant(P＜0.05).Conclusions:In eyes with advanced glaucoma,very thin but existing retinal nerve fiber layer is found on fdOCT.Such values rarely dropped below 20 to 30μm,and the correlation between structure and function was positive.