The Relationship Between the Blood Flow of Optic Nerve Head and Visual Field Defect in Two Cases of Optic Atrophy

Abstract

Abstract: : Purpose: We evaluated the blood flow at the neuroretinal rim area in two cases of optic atrophy with the visual field defects by Scanning Laser Doppler Flowmetry(Heidelberg Retina Flowmeter; HRF). Methods: Subjects:In the first case, 45 years old woman, was diagnosed as malignant hypertention due to Cushing syndrome and consulted our department. She had no abnormality in the anterior and intermediate segment but had severe narrowing of reinal arteries and papillary edema in her both eyes. Three months later her fundi showed optic atrophy and visual field defects were observed predominantly in the inferior area of her right eye and the superior area of left eye respectively. In the second case , 62 years old man,noticed inferior visual field defect in his right eye.He had no abnormality in the anterior and intermediate segment but had papillar edema in his right eye. Goldmann perimeter showed altitudinal inferior visual field defect in his right eye. He had a delay in arm-to-retina time at fluorocsein angiography. He was diagnosed as anterior ischemic optic neuropathy and his later examination showed optic atrophy in his right eye. Recording and Analysis: We recorded five images respectively at superior and inferior optic disc and calculated the means of flow values of superior and inferior area at the rim of the disc to get the ratios of the superior area to inferior by using HRF. Results: In the first case,the ratio of the superior area to inferior of the neuroretinal rim was 1.311 at the right eye and 0.675 at the left eye respectively. In the second case, the ratio is 0.040 at the right eye and 0.775 at the left eye respectively. These data showed that the reduction of the flow at the neuroretinal rim is associated with the visual field defects. Conclusions: These results strongly suggest that we could detect the reduction of blood flow of superior or inferior neuroretinal rim area in accordance with the visual field defect in cases of optic atrophy in which we are not able to detect the difference of blood flow between superior and inferior neuroretinal rim area ophthalmoscopically.

Keywords: neuro-ophthalmology: optic nerve • visual fields • optic flow