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Diane Wang, Rithambara Ramachandran, Lola M Grillo, Ravivarn Jarukasetphon, Paula Alhadeff, Gustavo De Moraes, Robert Ritch, Donald Hood; The relation between patterns of central (macular) glaucomatous damage, diagnostic categories, and disc-fovea angle. . Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):635.
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© ARVO (1962-2015); The Authors (2016-present)
To examine the association between the pattern of glaucomatous macular defects and diagnostic categories, as well as disc-fovea angle (DFA), using information from both frequency domain optical coherence tomography (fdOCT) and visual fields (VFs).
152 eyes of 152 glaucoma patients or suspects (56.1 ± 13.9yrs) had 24-2 mean deviations of -6 dB or better and an abnormal disc exam. All had macular and disc cube fdOCT scans, as well as 10-2 VFs. Retinal nerve fiber layer and the retinal ganglion cell plus inner plexiform layer thickness and probability plots were generated and displayed with VF information in a single-page report. The reports were evaluated by 3 experienced graders, and the eyes categorized by hemifield as normal or abnormal on OCT and 10-2 VF. Eyes with at least one hemifield abnormal on both OCT and VF were called “abnormal”, and eyes normal in both hemifields on both OCT and VF were called “normal”; the others were not analyzed further. The abnormal eyes were grouped by the pattern of macular damage (local, diffuse, or a combination of local and diffuse), diagnostic type (primary normal-tension [NTG], primary high tension [PHT], or secondary glaucoma [S], and intraocular pressure (IOP) (NTG vs. HTG [PHT +S]). The DFA was determined by centering and co-registering the disc and macular scans.
62 (40.8%) of the 152 eyes were abnormal and 42 (27.6%) were normal. Of the abnormal eyes, 35 had local, 19 had diffuse, and 9 had a combination of local and diffuse damage. This pattern of macular damage did not differ significantly by diagnosis (chi-sq test, p=0.49) or IOP (p=0.97). However, on average the VF defects in the NTG eyes were deeper and closer to fixation; the deepest average value in the upper 10-2 VF was -12 dB for NTG, -5.6 dB for PHT, -4.4 dB for S and -5 dB for HTG. The NTG eyes with upper hemifield damage had an average DFA of 8.3°, significantly greater than the normal eyes (6.3°, p=0.06), or the PHT or HTG eyes with upper hemifield damage (5.3°, p=0.02; 5.8° p=0.03).
The overall pattern of macular damage did not differ significantly by diagnosis category, although as expected the eyes with NTG tended to have deeper defects in the upper VF. These eyes with NTG and upper hemifield damage had larger DFAs than the other glaucomatous eyes or the eyes without defects. 1. Hood, Raza, et al. BJO. 2014.
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