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Jeffrey M. Liebmann, Carlos G. De Moraes, Danilo B. Fernandes, Christine L. Talamini, Ali S. Raza, Robert Ritch, Donald C. Hood; Glaucoma Patients with Clinically Normal Macular Appearance May Have Retinal Abnormalities. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1001.
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The incidence of non-glaucomatous abnormalities reported in the OHTS ranged from 2.1 to 4.0% and were due mainly to retinal diseases.[1,2] To test the hypothesis that macular abnormalities are even more common if clinical examination is combined with modern imaging techniques, we evaluated eyes with glaucomatous optic neuropathy (GON) with or without clinically detectable macular abnormalities using frequency domain optical coherence tomography (FDOCT).
In this cross-sectional study, we selected patients with GON with or without abnormal visual fields (VF) seen in a referral practice. Eyes were excluded if there was a detectable macular abnormality on clinical examination. 342 eyes of 244 patients (55% women; 83% Caucasian; mean age, 55.3±14.9 yrs; average VF mean deviation, MD, -4.1±4.8 dB) with normal macular appearance (indirect ophthalmoscopy with 78 D lens) were included. All patients underwent FDOCT examination of the optic nerve and macular region (Topcon Inc., Paramus, NJ) as part of their follow-up examination. Good quality (Q>60) horizontal and vertical FDOCT macular scans were reviewed by two masked investigators to determine if the macular region (6 x 6 mm scans) appeared normal. A retina specialist further classified abnormalities into three main categories: epiretinal membrane (ERM), edema, age-related macular degeneration (ARMD, dry and wet forms), and macular hole; more than one abnormality could be present in an eye.
FDOCT revealed macular abnormalities in 42/342 eyes (12.2%). ERM was the most common diagnosis (64.2%), followed by ARMD (50%), edema (14.2%), and macular hole (7%). The MD value and number of abnormal points (P<1%) in the central 10 degrees of the 24-2 VFs PD plots were worse in eyes with macular abnormalities as compared to age-matched eyes with no abnormalities on FDOCT (-3.9±3.6 vs -2.4±4.0 dB, P=0.07; 71.4% vs. 42.6%, P<0.01, respectively).
A high proportion (12.2%) of eyes with GON and clinically-normal macular appearance showed anatomic abnormalities of the macular region in FDOCT scans. The relationship between glaucoma, glaucoma treatment, and epiretinal membrane formation warrants further investigation. Routine FDOCT macular imaging may provide useful information regarding the extent of functional loss that can be attributed to retinal disease in glaucomatous eyes.1. Barnett et al Ophthal. 2010, 484-8. 2. Keltner et al. J Glau. 2007, 665-9. 3. Mirza et al. Surv Ophthalmol. 2007, 397-421.
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