April 2014
Volume 55, Issue 13
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ARVO Annual Meeting Abstract  |   April 2014
Peripapillary tilting predicts pattern of central vision loss in normal tension glaucoma
Author Affiliations & Notes
  • Shinichi Usui
    Ophthalmology, Osaka Univ Graduate School of Med, Suita, Japan
  • Yasushi Ikuno
    Ophthalmology, Osaka Univ Graduate School of Med, Suita, Japan
  • Tsutomu Kikawa
    Topcon corp., Itabashi-ku, Japan
  • Masahiro Akiba
    Topcon corp., Itabashi-ku, Japan
  • Tomoko Asai
    Ophthalmology, Osaka Univ Graduate School of Med, Suita, Japan
  • Atsuya Miki
    Ophthalmology, Osaka Univ Graduate School of Med, Suita, Japan
  • Kenji Matsushita
    Ophthalmology, Osaka Univ Graduate School of Med, Suita, Japan
  • Kohji Nishida
    Ophthalmology, Osaka Univ Graduate School of Med, Suita, Japan
  • Footnotes
    Commercial Relationships Shinichi Usui, None; Yasushi Ikuno, None; Tsutomu Kikawa, Topcon corp. (E); Masahiro Akiba, Topcon Corp. (E); Tomoko Asai, None; Atsuya Miki, None; Kenji Matsushita, None; Kohji Nishida, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 4029. doi:
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      Shinichi Usui, Yasushi Ikuno, Tsutomu Kikawa, Masahiro Akiba, Tomoko Asai, Atsuya Miki, Kenji Matsushita, Kohji Nishida; Peripapillary tilting predicts pattern of central vision loss in normal tension glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4029.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

Myopic glaucoma patients have a high risk of central visual loss. The pathogenesis of the central defects is deep structural deformation by ocular expansion in some myopic eyes. To quantify disc tilting in glaucomatous eyes, we studied the relation between peripapillary tilting by optical coherence tomography (OCT) and vision loss in highly and non-highly myopic normal tension glaucoma (NTG).

 
Methods
 

In this retrospective observational study, 162 NTG eyes were enrolled:highly myopic NTG group (axial length, AL≧26 mm) and non-highly myopic NTG group (AL<26 mm). High-penetration OCT (DRI-OCT1, Topcon, Japan) was used for optic disc imaging. 1. To measure disc tilting, a 4-mm-diameter circle scan image around the optic disc was extracted from the 6x6-mm 3D OCT volume image. The retinal pigment epithelium (RPE) line was traced, the image divided into 24 clock hours (Fig1, S1-S12 and I1-I12), and the average RPE line height in each sector calculated. 2. The peripapillary tilting index (PTI, pixels), i.e., the difference in RPE height between one sector and its counterpart, was evaluated. 3. The PTI of each sector was shown in the central optic disc as 0 pixel. The sector with minimal PTI (PTImin) shows the tilting direction. 4. PTI mapping. The ± degree between the tilting line with PTImin and the horizontal line of the optic disc was named the tilting degree, theta. The relation between tilting sectors and the visual field was evaluated. Threshold values of 4 paracentral points within 5° on the SITA30-2 test were used to evaluate central vision loss. The Tukey-Kramer multiple comparison test was used for statistical comparisons. Difference tests for multiple comparisons were considered significant at P<0.05.

 
Results
 

Eighty-one eyes were in each study group. In all NTG eyes, ~71% had tilting in 3 sectors: 34.5% in I1, 22.4% in I2 and 13.5% in S1 (Fig.2). Multiple comparisons of paracentral vision loss among those sectors found that highly myopic NTG with S1 and I1 tilting had significant inferior paracentral loss; non highly myopic NTG with S1 tilting had significant superior paracentral loss. The S1 mean deviation (-12.5±8.0 db) was significantly worse than I2 (-6.8±6.0 db) in highly myopic NTG.

 
Conclusions
 

The patterns of paracentral vision loss by peripapillary tilting differ between the two study groups. Deep structural optic disc changes may be affected by disc tilting in highly myopic eyes.

     
Keywords: 550 imaging/image analysis: clinical • 627 optic disc • 605 myopia  
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