June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Test of a hypothesis about the sites of early glaucomatous damage.
Author Affiliations & Notes
  • Jason Nunez
    Psychology, Columbia University, New York, New York, United States
  • C Gustavo De Moraes
    Ophthalmology, Columbia University, New York, New York, United States
  • Camile Scheharazade Shaw
    Psychology, Columbia University, New York, New York, United States
  • Ravivarn Jarukasetphon
    Psychology, Columbia University, New York, New York, United States
    Ophthalmology, New York Eye & Ear Infirmary , New York, New York, United States
  • Robert Ritch
    Ophthalmology, New York Eye & Ear Infirmary , New York, New York, United States
  • Donald Hood
    Psychology, Columbia University, New York, New York, United States
    Ophthalmology, Columbia University, New York, New York, United States
  • Footnotes
    Commercial Relationships   Jason Nunez, None; C Gustavo De Moraes, None; Camile Shaw, None; Ravivarn Jarukasetphon, None; Robert Ritch, None; Donald Hood, Heidelberg Engineering (F), Heidelberg Engineering (R), Topcon Inc. (F), Topcon Inc. (R)
  • Footnotes
    Support  NEI RO1-EY-02115, NEI EY025253, Joseph and Geraldine LaMotta Research Fund of the New York Glaucoma Research Institute
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 702. doi:
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      Jason Nunez, C Gustavo De Moraes, Camile Scheharazade Shaw, Ravivarn Jarukasetphon, Robert Ritch, Donald Hood; Test of a hypothesis about the sites of early glaucomatous damage.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):702.

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

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Abstract

Purpose : Based upon the location of local circumpapillary retinal nerve fiber layer (cpRNFL) thinning, [1] we hypothesize that the temporal halves of the superior and inferior quadrants of the disc are particularly vulnerable to early glaucomatous damage. Here we test this hypothesis.

Methods : 87 of 205 eyes with abnormal/anomalous discs, but with a mean deviation (MD) better than -6dB on 24-2 visual fields, were judged as glaucomatous by two experts based upon disc stereo-photos, 24-2 and 10-2 visual fields, an OCT summary report,[2] as well as information from the patients’ charts. The OCT summary report (Fig. 1) was based upon a swept source OCT wide-field cube scan (9x12 mm, DRI-OCT, Topcon, Inc). The region of the cpRNFL thickness plot falling into the red (1%) zone in Fig. 1A was considered abnormal, as were the regions of the RNFL (Fig. 1B) and retinal ganglion cell layer (Fig. 1C) appearing as red (1%) on the probability plots. The hypothesis is represented in Fig. 2, which shows the disc of a right eye with the superior (SVZ, orange) and inferior vulnerability zones (IVZ, green) indicated and the regions representing the macula shown in light blue and magenta. The macular vulnerability zone (MVZ) [3] is shown in black.

Results : The example in Fig. 1 shows cpRNFL thinning (upper left panel A) that includes the IVZ (red arrow) and MVZ (black arrow). The damage to these regions is confirmed on the RNFL and RGC probability plots as indicated by the arrows. As predicted by the hypothesis, 84 (96.6%) of the 87 eyes, had damage in the SVZ (55, 63.2%), the IVZ (69, 79.3%) or both SVZ and IVZ (40, 46.0%). The remaining 3 eyes also had damage in the IVZ, although it was only borderline (yellow) on the cpRNFL plot. Damage to the macula was common (74 eyes, 85.1%), with damage to the inferior macula (62 eyes, 71.3%) more common than damage to the superior macula (41 eyes, 47.1%). Damage outside the macula was also common (84 eyes, 96.6%). Three eyes only had macular damage, while 13 eyes only had damage outside the macula.

Conclusions : Early glaucomatous damage typically includes one or both of the temporal halves of the inferior and superior quadrants. Further, as previously shown, it usually involves the macular region.[3] 1. Hood, Wang, Raza et al. (2013) IOVS, 54, 7338; 2. Hood, De Cuir, Blumberg et al. (2016) TVST, 5, 4; 3. Hood, Raza, de Moraes et al. (2013) PRER, 32, 1.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

 

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