Intra-individual, Inter-ocular Comparison In Normal Tension Glaucoma with Unilateral Field Loss

Dong Hoon Lee; Changwon Kee

doi:10.3341/jkos.2008.49.1.125

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Lee and Kee: Intra-individual, Inter-ocular Comparison In Normal Tension Glaucoma with Unilateral Field Loss

Original Article

J Korean Ophthalmol Soc 2008;49(1):125-134.

Published online: 3 August 2008

DOI: https://doi.org/10.3341/jkos.2008.49.1.125

Intra-individual, Inter-ocular Comparison In Normal Tension Glaucoma with Unilateral Field Loss

Dong Hoon Lee, M.D., Changwon Kee, M.D., Ph.D.

Department of Ophthalmology, Samsung Medical Center, College of Medicine, Sungkyunkwan University, Seoul, Korea

Address reprint requests to Changwon Kee, M.D. Ph.D. Department of Ophthalmology, Samsung Medical Center, School of Medicine, Sungkyunkwan University #50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: 82-2-3410-3564, Fax: 82-2-3410-0074, E-mail: cwkee@smc.samsung.co.kr

Received 27 December 2006 Accepted 17 September 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 whether there are differences in ocular risk factors reportedly associated with the development of normal tension glaucoma (NTG) between glaucomatous eyes and normal visual field (VF) eyes of monocular NTG patients.

Methods

Thirty-six patients who had NTG in one eye and normal RNFL and VF in the fellow eye were included in this hospital-based cross-sectional retrospective survey. We analyzed the difference between glaucomatous eyes and normal VF eyes according to an intra-individual, inter-ocular comparison of ocular parameters, including intraocular pressures (IOP), central corneal thickness (CCT), optic disc size, myopia, optic disc hemorrhage, and zone β of peripapillary atrophy. Measurements of optic disc size and area and the angular and radial extent of zone β were obtained using a Heidelberg Retina Tomograph. We also evaluated the correlation of each parameter with mean deviation (MD) and pattern standard deviation (PSD).

Results

There were no inter-ocular differences of IOP, CCT, optic disc size, or myopia (n=36). Optic disc hemorrhage was found in only three glaucomatous eyes. The area of zone β was greater in glaucomatous eyes than in normal VF eyes (p=0.003). No parameters were correlated with MD or PSD.

Conclusions

Except for optic disc hemorrhage and zone β area, all other parameters showed no inter-ocular differences. The asymmetry of disc hemorrhage and zone β area in monocular NTG patients implies that optic disc ischemia might play a role in the pathogenesis of NTG.

Keywords: Ischemia, Normal tension glaucoma, Optic disc hemorrhage, Zone β

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Table 1.

Comparison between the glaucomatous eye and the normal visual field (VF) Eye

	Number of Subjects	Glaucomatous eye	Normal VF eye	p value^*
BCVA (LogMar)	36	0.01±0.03	0.01±0.03	0.520
Mean deviation (dB)	36	-6.4±5.5	-1.2±1.7	< 0.001
Pattern standard deviation (dB)	36	8.6±4.7	2.1±0.6	< 0.001
Baseline IOP (mmHg)	36	17.2±2.5	16.7±3.0	0.143
Modified IOP (mmHg)	36	17.1±3.4	16.9±3.8	0.831
Spherical equivalents (diopters)	36	-1.69±2.3	-1.31±1.9	0.074
Central corneal thickness (µm)	36	532.8±30.7	529.5±28.1	0.246
Optic disc hemorrhage (eyes)	36	3/36	0/36	0.239^†
Optic disc size (mm²)	22	2.58±0.61	2.54±0.57	0.792
Zone β parameters
Prevalence	36	17/36 (47%)	15/36 (42%)	0.500^‡
Area (mm²)	22	0.65±1.42	0.43±0.87	0.003
Angular extent (degree)	22	128.0±149.6	108.2±139.2	0.148
Radial extent (mm)	22	0.30±0.51	0.20±0.30	0.163
Zone β area / disc area	22	0.26±0.54	0.16±0.29	0.004

^* Paired t test and Wilcoxon rank sum test (for spherical equivalents, variables related to zone β) were used according to the normality of distribution of difference between fellow eyes.

^† Fisher’s exact test.

^‡ Mcnemar’s test.

Table 2.

Correlation between ocular parameters and mean deviation (MD), pattern standard deviation (PSD)

	Number of subject	Δ _MD^*	P value^†	Δ PSD	P value^‡
Δ Baseline IOP (mmHg)	36	0.01	0.472	-0.09	0.328
Δ Modified IOP (mmHg)	36	0.44	0.152	-0.07	0.360
Δ Spherical equivalents (diopters)	36	0.07	0.341	-0.24	0.087
Δ Central corneal thickness (µm)	36	0.20	0.524	-0.13	0.695
Δ Optic disc size (mm²)	22	0.26	0.244	-0.19	0.386
Zone β parameters
Δ Area (mm²)	22	-0.68	0.349	0.05	0.382
Δ Angular extent (degree)	22	-0.60	0.365	-0.05	0.384
Δ Radial extent (mm)	22	-3.11	0.034	0.25	0.077
Δ Zone β area / disc area	22	-0.49	0.390	0.02	0.460

^* Δ parameter=(parameter of glaucomatous eye)- (parameter of normal visual field eye).

^† Pearson correlation analysis and Spearman correlation analysis (for spherical equivalents, variables related to zone β) were used according to the normality of distribution of data.

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