Change in Optic Nerve Head Topography in Progression of Early Glaucoma

Eun-Ryung Han; Wool Suh; Soo Young Lee; Kyu Ryong Choi

doi:10.3341/jkos.2007.48.9.1248

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Han, Suh, Lee, and Choi: Change in Optic Nerve Head Topography in Progression of Early Glaucoma

Original Article

J Korean Ophthalmol Soc 2007;48(9):1248-1256.

Published online: 30 August 2007

DOI: https://doi.org/10.3341/jkos.2007.48.9.1248

Change in Optic Nerve Head Topography in Progression of Early Glaucoma

Eun-Ryung Han, M.D., Wool Suh, M.D., Soo Young Lee, M.D., Kyu Ryong Choi, M.D.

The Institute of Ophthalmology and Optometry; Department of Ophthalmology, School of Medicine, Ewha Womans University, Seoul, Korea

Address Reprint requests to Kyu Ryong Choi, M.D., Department of Ophthalmology, Mokdong Hospital, School of Medicine, Ewha Womans University, #911-1 Mok-dong, Yangcheon-gu, Seoul 158-050, Korea, Tel: 82-2-2650-5031, Fax: 82-2-2654-4334, E-mail: ckrey02@imim.ewha.ac.kr

Received 31 January 2007 Accepted 13 June 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the clinical manifestation and the structural optic disc changes according to the development of reproducible visual field defects in a group of preperimetric patients converting to early glaucoma.

Methods

Standard automated perimetry (Humphrey Field Analyzer) was performed every six months in 294 preperimetric patients. Each subject was classified as either converter or non-converter according to glaucomatous visual field changes, and the clinical manifestations were analyzed retrospectively. Sequential optic disc images were obtained using the TopSS scanning laser ophthalmoscope (TopSS^TM) and optic disc parameters were measured to determine if any change had occurred.

Results

A total of 44 eyes from 44 subjects (14.9%) in 294 patients subsequently developed early glaucomatous field loss (converters). The progression rate of visual field defect is 0.43dB/year. In respect to age, sex, refractive error, and diabetes mellitus, no significant differences were observed. Elevated IOP, hypertension, and family history of glaucoma were detected more frequently in the converter group than in the non-converter group. Among TopSS parameters, cup-to-disc ratio, effective area, volume above, maximum slope, and neuroretinal rim area showed statistically significant change. Changes of the neuroretinal rim were prominent in superior and inferior sectors.

Conclusions

Among TopSS parameters, cup-to-disc ratio, effective area, volume above, and neuroretinal rim are useful in detecting the progression of glaucoma. Furthermore, neuroretinal rim changes in each sector may provide clinically relevant information in detecting and monitoring the progression of glaucoma.

Keywords: Early glaucoma, Optic nerve head topography, Visual field progression

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Figure 1.

Diagram of neuroretinal rim area in 12 sectors in the left eye. Each sectors counted in a clockwise manner in the left eyes and in a counterclockwise in the right eyes. (12 o'clock=superior, 3 o'clock=temporal).

Figure 2.

Comparisons of neuroretinal rim area by sector within converter group Each sectors counted in a clockwise manner in the left eyes and in a counterclockwise in the right eyes.

Table 1.

Baseline demographics and visual field indices in converter and non-converter group

	Converter	Non-converter	p-value^∗
No. of eyes (%)	44 (14.9)	250 (85.1)	−
Age (years)	54.1±13.5	51.3±9.8	NS
IOP (mm Hg)	19.5±3.7	14.2±6.2	p<0.05
RE (diopter)	−0.75±3.53	−1.23±2.54	NS
MD (dB)	−1.49±1.75	−1.62±2.21	NS
PSD (dB)	1.58±2.43	1.71±2.87	NS
Follow-up period (months)	53.8±17.1	47.8±19.9	NS

mean±standard deviation.

^∗ : student t-test.

NS: not significant.

IOP: intraocular pressure.

RE: refractive error.

MD: mean deviation.

PSD: pattern standard deviation.

Table 2.

Sex distribution and risk factors in converter and non-converter group

	Converter	Non-converter	p-value
Gender
Male (%)	26 (59)	147 (59)	NS^∗
Female (%)	18 (41)	103 (41)
HTN (%)	28 (64)	32 (3)	p<0.05^†
DM (%)	11 (25)	78 (31)	NS^†
Family history of Glaucoma (%)	10 (23)	1 (0.4)	p<0.05^†
No. of eyes (%)	44 (100)	250 (100)

^∗ : analysis of variance.

^† : chi-square test.

NS: not significant. HTN: hypertension.

DM: diabetes mellitus

Table 3.

Baseline topographic parameter between converter and non-converter group

	unit	Converter	Non-converter	p-value^∗
Mean contour depth	mm	−0.11±0.12	−0.10±0.14	NS
Effective area	mm²	1.40±0.56	1.34±0.34	p<0.05
Average depth	mm	−0.28±0.07	−0.29±0.10	NS
Volume above	mm³	0.16±0.09	0.18±0.03	p<0.05
Volume below	mm³	−0.40±0.21	−0.44±0.31	NS
1/2 depth area	mm²	0.64±0.38	0.63±0.24	NS
1/2 depth volume	mm³	−0.09±0.07	−0.09±0.05	NS
Maximum depth	mm	−0.64±0.21	−0.83±0.10	NS
Maximum slope	degree	77.66±2.93	78.97±4.47	NS
Average slope	degree	35.22±5.01	36.80±6.02	NS
Contour variation	mm	0.34±0.12	0.36±0.11	NS
Cup shape	−	−0.05±0.03	−0.05±0.05	NS
C/D ratio	−	0.62±0.17	0.59±0.15	NS
Horizontal C/D ratio	−	0.61±0.19	0.60±0.14	NS
Vertical C/D ratio	−	0.62±0.18	0.59±0.21	NS
NRRA	mm²	0.97±0.38	0.96±0.20	NS

mean±standard deviation.

^∗ : student t-test.

NS: not significant.

NRRA: neuroretinal rim area.

Table 4.

Change of visual field indices within converter group

	Baseline	At the time of conversion	p-value^∗
MD (dB)	−1.49± 1.75	−3.36± 1.62	p<0.05
PSD (dB)	1.58±2.43	2.43± 1.33	p<0.05

mean±standard deviation.

^∗ : paired t-test.

MD: mean deviation.

PSD: pattern standard deviation.

Table 5.

Comparisons of topographic parameters within converter group according to development of glaucomatous visual field defect

	unit	Baseline	At the time of conversion	p-value^∗
Mean contour depth	mm	−0.10±0.12	−0.11±0.14	NS
Effective area	mm²	1.40±0.56	1.46±0.63	p<0.05
Average depth	mm	−0.28±0.07	−0.27±0.10	NS
Volume above	mm³	0.16±0.09	0.13±0.07	p<0.05
Volume below	mm³	−0.40±0.21	−0.42±0.27	NS
1/2 depth area	mm²	0.64±0.38	0.62±0.36	NS
1/2 depth volume	mm³	−0.09±0.07	−0.09±0.08	NS
Maximum depth	mm	−0.64±0.20	−0.61±0.20	NS
Maximum slope	degree	77.66±2.93	76.44±3.75	p<0.05
Average slope	degree	35.22±5.01	34.63±6.20	NS
Contour variation	mm	0.34±0.12	0.36±0.11	NS
Cup shape	−	−0.05±0.03	−0.05±0.05	NS
C/D ratio	−	0.62±0.17	0.74±0.15	p<0.05
Horizontal C/D ratio	−	0.61±0.19	0.82±0.14	p<0.05
Vertical C/D ratio	−	0.62±0.18	0.72±0.11	p<0.05
NRRA	mm²	0.97±0.38	0.81±0.32	p<0.05

mean±standard deviation.

^∗ : paired t-test.

NS: not significant.

NRRA: neuroretinal rim area.

Table 6.

Comparisons of neuroretinal rim area by sector within converter group

Sector(mm²)	Disc sectors^†	Baseline	At the time of conversion	p-value^∗
Superior	12	0.11±0.05	0.10±0.04	p<0.05
Superotemporal	1+2	0.04±0.03	0.04±0.04	NS
Temporal	3	0.01±0.02	0.01±0.02	NS
Inferotemporal	4+5	0.04±0.03	0.03±0.03	p<0.05
Inferior	6	0.12±0.04	0.10±0.04	p<0.05
Inferonasal	7+8	0.13±0.05	0.10±0.04	p<0.05
Nasal	9	0.10±0.06	0.09±0.04	NS
Superonasal	10+11	0.10±0.05	0.09±0.04	NS

mean±standard deviation.

^∗ : paired t-test.

^† : each sectors counted in a clockwise manner in left eyes and in a counterclockwise in right eyes.

NS: not significant.

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