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L.S. Jones, C.M. Schneider; Heidelberg Retina Tomograph Stereometric Parameters in African–American Patients with No, Early, Moderate, and Severe Glaucomatous Visual Field Defects . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3340.
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Purpose: To determine if a correlation exists between stereometric parameters of the optic nerve head measured by the Heidelberg Retina Tomograph II (HRT II) and severity of glaucomatous visual field deficits measured by Humphrey Visual Fields (HVF) in an African–American patients attending an urban glaucoma clinic. Mehods: A retrospective chart review of 56 patients (88 total eyes) who attended the Glaucoma Service at Howard University Hospital from May 2002 to May 2003 and underwent baseline HRT II evaluation was performed. All the patients included in the study had documentation of a complete ophthalmic evaluation including biomicroscopy of the anterior segment, Goldman tonometry, indirect ophthalmoscopy in addition to SITA standard HVF testing and HRT II baseline examination. The study participants were divided into four groups of disease severity: no, early, moderate, and severe based on a modified Hodapp–Parrish–Anderson staging system to classify the magnitude of the glaucomatous visual field defect and the proximity of the defect to fixation. Results: Of the 88 eyes included in the study, 48 had no defect, 16 had early, 12 had moderate, and 12 had severe defects. Analysis of variance (ANOVA) was used to compare HRT II parameters and HVF indices to the four study groups. A correlation was noted between the following HRT II parameters and disease severity: disc area (p=0.018), rim area (p=0.0009), mean RNFL thickness (p=0.007), RNFL CSA (p=0.002), C/D area ratio (p=0.0067), linear C/D ratio (p=0.025), rim volume (p=0.0025), and maximum cup depth (p=0.023). HVF pattern standard deviation was highly correlated to disease severity as well. When comparing one individual study group to another rim volume was significant (p=0.001) in the no defect group vs. the severe group and p=0.028 in early vs. severe), cup/disc area ratio (p=0.023/0.025), linear cup/disc ratio (p=0.025/0.027), mean RNFL thickness (p=0.002/0.023), RNFL CSA (p=0.003/0.024). In the moderate vs. severe group the cup/disc area ratio (p=0.038) and linear cup/disc ratio (p=0.045) were both statistically significant as well. Conclusions: The HRT II stereometric parameters were not as good predictors of disease severity in groups that were in close proximity to each other, for instance early vs. moderate defect, due to the overlap that occurred between these groups. However the rim volume, cup/disc area ratio, linear cup/disc ratio, mean RNFL thickness, and RNFL CSA were all statistically significant when comparing the no vs. severe defect and early vs. severe defect groups.
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