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Ziad Butty, Jayme R Vianna, Lucas A Torres, Glen Sharpe, Donna Hutchison, Lesya M Shuba, Paul E Rafuse, Marcelo Nicolela, Balwantray C Chauhan; The Temporal Raphe of the Retinal Nerve Fibre Layer and Ganglion Cell Layer in Glaucoma Patients with a Horizontal Hemi-field Visual Field Defect. Invest. Ophthalmol. Vis. Sci. 2017;58(8):695.
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To determine whether the angle between the fovea and the temporal raphe (temporal raphe angle, TRA) respected the angle of a clear nasal step visual field (VF) defect.
Open-angle glaucoma patients followed in a prospective study who had all 5 locations immediately above or below the horizontal midline with a pattern standard deviation value of P < 0.5% in at least the last 3 consecutive VF (24-2, Humphrey Field Analyzer) were recruited (Figure 1-A). Two optical coherence tomography macular scans were performed; a 30°x15° comprising 398 B-scans aligned to horizontal image frame, and a 30°x25° comprising 61 B-scans aligned to the fovea to Bruch’s membrane opening (FoBMO) angle. A customized VF with 7 stimuli separated by 1° vertically at each of 5 horizontal eccentricities (6° apart) nasal to the fovea was performed. The TRA of the RNFL reflectance was measured (Figure 1-C). The ganglion cell layer angle (GCLA) was measured with the best-fit line of the highest difference in GCL thickness and the FoBMO axis centred on fovea (Figure 1-D). The VF defect angle was measured with a best fit line with the highest difference in sensitivity at each horizontal eccentricity and the fovea (Figure 1-B).
We included 12 (7 right and 5 left) eyes of 9 patients with median age of 67 (range: 63 to 74) years. There were 9 patients with an inferior hemi-field VF defect. The FoBMO angle was always negative with a median of -7.45° (-9.9° to -1.4°) while the median TRA, relative to horizontal, was +2.98° (-1.76° to +11.59°). The GCLA did not correspond to the FoBMO axis (median difference, +2.24° (range, 0.09° to 6.31°). The correlation between the TRA and VF angles (rho= 0.62, p= 0.04) was higher than that between the TRA and FoBMO angle (rho = -0.17, p = 0.59).
Glaucomatous hemifield scotomas do not respect the horizontal midline. Instead, the VF angle correlated with the orientation of the RNFL temporal raphe which itself is variable among patients and does not respect the horizontal midline. Additionally, the highest vertical asymmetry of GCL thickness did not follow the FoBMO axis demonstrating an additional aspect of inter-individual anatomical variation.
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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