July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Effect modification of refractive error on visual field pattern deviation in glaucoma
Author Affiliations & Notes
  • Qingying Jin
    Department of Psychology, Jilin University, Changchun, Jilin, China
    Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, United States
  • Thuzar Thein
    Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, United States
  • Louis R. Pasquale
    Mass. Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
  • Lucy Q Shen
    Mass. Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
  • Michael V Boland
    Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Sarah R. Wellik
    Bascom Palmer Eye Institute, Miami, Florida, United States
  • C Gustavo De Moraes
    Edward S. Harkness Eye Institute, Columbia University, New York, New York, United States
  • Jonathan S. Myers
    Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Peter J. Bex
    Department of Psychology, Northeastern University, Boston, Massachusetts, United States
  • Neda Baniasadi
    Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, United States
  • Dian Li
    Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, United States
  • Hui Wang
    Institute for Psychology and Behavior, Jilin University of Finance and Economics, Changchun, Jilin, China
    Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, United States
  • Mengyu Wang
    Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, United States
  • Tobias Elze
    Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Qingying Jin, None; Thuzar Thein, None; Louis Pasquale, Alcon-Speaker (S), Bausch+Lomb (C), Eyenovia-Advisory board member (S); Lucy Shen, Genentech – Consultant (C), Topcon - Research funding (F); Michael Boland, Alcon - Grant support (F); Sarah Wellik, None; C Gustavo De Moraes, None; Jonathan Myers, None; Peter Bex, United States PCT/US2014/052414 (P); Neda Baniasadi, None; Dian Li, None; Hui Wang, None; Mengyu Wang, None; Tobias Elze, United States PCT/US2014/052414 (P)
  • Footnotes
    Support  Louis R. Pasquale: NEI R01 EY015473. Lucy Q. Shen: Topcon - Research funding.Michael V. Boland: Alcon - Grant support. Sarah R. Wellik: NIH Center Core Grant P30EY014801, Research to Prevent Blindness Unrestricted Grant. Carlos Gustavo de Moraes: Unrestricted departmental grant from Research to Prevent Blindness. Neda Baniasadi and Mengyu Wang:Lions Foundation, Grimshaw-Gudewicz Foundation, Research to Prevent Blindness BrightFocus Foundation, NEI Core Grant P30EYE003790. Hui Wang: Jilin University of Finance and Economics, No.2017Z02.Tobias Elze: Grant support: Lions Foundation, Grimshaw-Gudewicz Foundation, Research to Prevent Blindness BrightFocus Foundation, NEI Core Grant P30EYE003790.
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 5134. doi:
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      Qingying Jin, Thuzar Thein, Louis R. Pasquale, Lucy Q Shen, Michael V Boland, Sarah R. Wellik, C Gustavo De Moraes, Jonathan S. Myers, Peter J. Bex, Neda Baniasadi, Dian Li, Hui Wang, Mengyu Wang, Tobias Elze; Effect modification of refractive error on visual field pattern deviation in glaucoma. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5134.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Since glaucoma tends to produce specific visual field defects, the pattern deviation (PD) plot, which shows relative light sensitivity at each VF location, is crucial for the functional diagnosis of glaucoma. We studied effect modification of refractive error on PD values as a function of glaucoma severity.

Methods : In this retrospective study, the most recent reliable automated VFs (fixation loss≤33%, false negative/positive rates≤20%, SITA Standard 24-2) were selected among all patients from five clinical glaucoma practices. PD values at each VF location were modeled by linear regression with spherical equivalent (SE), mean deviation (MD), and their interaction (SE×MD) as regressors. P values of the slopes were adjusted for multiple comparisons.

Results : 120,019 eyes of 70,495 patients were selected (medians/[5th;95th] percentiles of age: 66.7 [34.7;86.5] years; MD: -2.7 [-20.2;0.9] dB; SE: -0.4 [-5.75;3.00] D). Fig. 1A shows the isolated effect of SE (i.e. unexplained by MD) on PD. Among all VF locations, 34.6% (predominantly central/infero-temporal) and 36.5% (predominantly peripheral/nasal) showed higher respectively lower PD values with increasing myopia. Fig. 1B illustrates significant interaction effects (SE×MD) on 82.7% of VF locations. With increasing myopia and increasing glaucoma severity, central/nasal VF areas become more depressed and peripheral/temporal areas less depressed. Fig. 2 quantifies the effect of SE on PD separately for the group with at most mildly depressed VFs (MD within ±1dB) vs. severely depressed VFs (MD < -12dB). Significant SE slopes range from -0.11 to +0.04 in mildly depressed VFs and from -0.23 to +0.19 in severely depressed VFs. This means, for severe glaucoma, high myopes (SE: -6D) have up to 2.28 dB lower and up to 2.76 dB higher PDs values than high hyperopes (SE: +6D).

Conclusions : Ametropia in isolation (Fig. 1A) as well as the interaction between ametropia and glaucoma severity (1B) were found to have significant effects on PD values. The two major retinal nerve fiber bundles, known to be vulnerable to glaucomatous damage, are closer to the fovea with increasing myopia (1C). The interaction results (1B) are consistent with a relative increase of glaucomatous VF loss at the individual locations of these bundles compared to the rest of the visual field. In severe glaucoma, single PDs differ by more than 2 dB between high myopes and hyperopes.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

 

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