Abstract
Purpose :
Guidelines about neuroimaging for patients with nonglaucomatous visual field defect (VFD) are sparse. We performed a retrospective, cross-sectional study to analyze the clinical presentations and neuroimaging findings of patients with nonglaucomatous VFD.
Methods :
We included patients who underwent brain magnetic resonance imaging (MRI) for differential diagnosis of their nonglaucomatous VFD between 2013 and 2022. Patients with neurologic symptoms other than decreased visual acuity, those who have history of brain lesion, or those with systemic medication known to cause optic neuropathy were excluded. Demographic and ophthalmic characteristics were analyzed. The reasons for conducting brain MRI were classified into three: (1) VFD respecting vertical meridian, (2) VFD inconsistent with IOP or structural change, and (3) VFD with fast progression (aggravation of mean deviation over 1.5 dB per year). Logistic regression was conducted to identify independent risk factors for significant lesion responsible for nonglaucomatous VFD.
Results :
A total of 159 patients (258 eyes) had undergone brain MRI, and 95 patients (169 eyes) had been diagnosed with open-angle glaucoma for at least one eye. For the pattern of VFD, arcuate VFD was the most common (36.9%) but the frequency of VFD pattern showed a significant difference depending on the glaucoma history (p=0.007). 29 patients (42 eyes) showed significant finding and intracranial tumor was the most common finding (9 patients), followed by cerebrovascular accident (6 patients). Presence of peripapillary atropy was associated with a 65% reduction in relative risk of significant finding in brain MRI (odds ratio [OR] 0.353, 95% confidence interval [CI] 0.136-0.919, p=0.033). Older age (OR 1.049, 95% CI 1.018-1.081, p=0.002), presence of visual acuity symptoms (OR 5.79, 95% CI 2.361-14.195, p<0.001), presence of incomplete homonymous hemianopsia (OR 15.167, 95% CI 3.096-74.30, p=0.001), and reason for taking brain MRI, VFD with fast progression, (OR 4.385, 95% CI 1.266-15.189, p=0.02) were analyzed to be independent risk factors for significant finding in brain MRI.
Conclusions :
VFD with nongluacomatous pattern or progression may indicate lesion along visual pathway. For nonglaucomatous VFD, neuroimaging is recommended for patients who are older or with decreased visual acuity. It is also recommended for fast progression or incomplete homonymous hemianopsia.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.