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Ayda M Shahidi, Christopher Hudson, Sunni R Patel, David Huang, Ou Tan, Yvonne M Buys, Graham Eric Trope, John G Flanagan; Assessment of retinal blood flow in patients with glaucoma related altitudinal visual field asymmetry. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2938.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate retinal blood flow (RBF) in glaucoma related asymmetrical altitudinal visual field (VF) damage
Using the RTVueTM FD-OCT double-circular Doppler scan protocol, RBF scans were captured in 13 participants with primary open angle glaucoma (POAG) (69±8yrs, 6 males[M]) with altitudinal VF asymmetry (present if different stages of the visual field score, based on Hoddap criteria, were found when comparing the superior and inferior VF hemispheres), 6 patients with POAG and no VF asymmetry (66±5yrs, 3M) and 4 healthy participants (69.8±5.5yrs, 3M). Total and hemispheric RBF values were compared between the two POAG groups. Patients were additionally classified as having mild glaucoma (VF mean deviation MD≤-6; n=12) or moderate-to-severe glaucoma (MD>-6; n=7) and total (T) RBF was compared to healthy controls (ANOVA). Pearson correlation analysis was used to assess the relationship between RBF and MD in the entire POAG group.
All asymmetric VF defects were more severe in the superior hemifield and the inferior (I) RBF was significantly lower compared to the superior (S) RBF (13.01±3.00 µl/min vs 19.49±3.19 µl/min, p<0.0001). No significant difference was found between the SRBF and IRBF for POAG without altitudinal asymmetry (17.95±5.47 µl/min vs 17.93±2.85 µl/min respectively; p=0.99) or the healthy participants (27.72±5.48 µl/min vs 20.82±5.94 µl/min respectively; p=0.14). Mean TRBF was slightly lower in POAG patients with asymmetrical VF defect compared to those without but not statistically significant (32.26±5.20 µl/min vs 35.88±4.21 µl/min; p=0.15). When patients were grouped based on MD and compared with controls, average TRBF was significantly different between groups (controls 48.55±1.20 µl/min; mild POAG 35.71±3.38 µl/min; and moderate-severe POAG 29.83±5.51 µl/min, F=31.23, p<0.0001). Decreased TRBF was significantly correlated with severity of VF defect as measured by MD (r=0.46, p=0.04).
Patients with POAG and superior VF defect had significantly lower RBF in the inferior retinal hemifield as shown by Doppler FD-OCT. Patients with moderate-to-severe POAG had significantly lower TRBF compared to those with mild POAG and healthy participants. These results suggest that altitudinal asymmetrical VF defects in glaucoma are associated with regional reduction of the blood flow to the retina.
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