Correlation Between Macular, Retinal Nerve Fiber Layer Thickness, and Visual Field in Open Angle Glaucoma

Won-Do Jeong; Dongeun Lee; Joo-Hwa Lee; Joon-Woo Shin

doi:10.3341/jkos.2009.50.2.227

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Jeong, Lee, Lee, and Shin: Correlation Between Macular, Retinal Nerve Fiber Layer Thickness, and Visual Field in Open Angle Glaucoma

Original Article

J Korean Ophthalmol Soc 2009;50(2):227-234.

Published online: 3 January 2009

DOI: https://doi.org/10.3341/jkos.2009.50.2.227

Correlation Between Macular, Retinal Nerve Fiber Layer Thickness, and Visual Field in Open Angle Glaucoma

Won-Do Jeong, MD¹, Dongeun Lee, MD², Joo-Hwa Lee, MD¹, Joon-Woo Shin, MD¹

¹Department of Ophthalmology, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea

²Department of Ophthalmology, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Korea

Address reprint requests to Joo-Hwa Lee, MD Department of Ophthalmology, Inje University Sanggye Paik Hospital #761-1 Sanggye 7 dong, Nowon-gu, Seoul 139-707, Korea Tel: 82-2-950-1096, Fax: 82-2-935-6904, E-mail: joohlee@paik.ac.kr

Received 30 June 2008 Accepted 24 November 2008

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

This study was performed to evaluate the macular and peripapillary retinal nerve fiber layer (RNFL) thickness and to evaluate their association with glaucomatous visual field change.

Methods

Forty normal eyes of 24 subjects, 30 ocular hypertension eyes of 15 patients, 30 pre-perimetric glaucoma eyes of 18 patients and 90 open angle glaucoma eyes of 59 patients. The macularand peripapillary RNFL thickness were measured by the optical coherence tomography (Stratus OCT ^TM model 3000, Carl Zeiss Meditec) and visual field tests were performed by the Humphrey’s automated perimetry.

Results

There was a significant decrease of both the macular (p＜0.05) and peripapillary RNFL thickness (p＜0.001) in the open angle glaucoma group compared with the normal group. In 190 eyes, statistically significant positive relationship was demonstrated between mean deviation (MD) and all areas of peripapillary RNFL thickness (p＜0.001) as well as between MD and all areas of macular thickness except the fovea, central ring (p＜0.01).

Conclusions

The macular and peripapillary RNFL thickness were significantly decreased and the findings indicated a significant association with the visual field change in open angle glaucoma eyes.

Keywords: Macular thickness, Optical coherence tomography, Retinal nerve fiber layer, Visual field defect

References

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Figure 1.

(A) Relationship between the mean deviation (MD) (dB) and the mean peripapillary retinal nerve fiber layer (RNFL) thickness (μm), n=190; Pearson correlation coefficient=0.554 (p <0.001), and relationship between the mean deviation (MD) (dB) and the mean macular thickness (μm), n=190; Pearson correlation coefficient=0.513 ( p <0.001). (B) Relationship between the mean macular thickness (μm) and the mean peripapillary retinal nerve fiber layer (RNFL) thickness (μm), n=190; Pearson correlation coefficient=0.513 (p <0.001); ^*MD=mean deviation; ^† dB=decibel; ^‡ RNFL=retinal nerve fiber layer.

Table 1.

Clinical characteristics of the subjects

	Normal (n=40 eyes)	OHT^П(n=30)	Pre-perimetric (n=30)	Early defect (n=30)	Moderate defect (n=30)	Severe defect (n=30)	p^*
Age (yrs) (mean± SD)	58.7±7.2	58.9±7.8	59.4±8.5	61.4±6.6	61.1±9.0	60.5±8.0	0.282
Sex (M:F)	23:17	14:16	17:13	16:14	18:12	18:12	0.571
MD^‡(mean± SD)	-1.21±1.49	-0.90±0.91 p=0.458^†	-0.99±1.07 p=0.607^†	-3.61±1.75 p<0.001^†	-9.25±1.67 p<0.001^†	-19.32±4.89 p<0.001^†	<0.001
PSD^§(mean± SD)	1.87±1.13	2.28±1.34 p=0.301^†	2.52±1.36 p=0.106^†	4.51±1.69 p<0.001^†	9.25±3.28 p<0.001^†	12.1±1.95 p<0.001^†	<0.001

^* p=ANOVA;

^† Analysis of variance with post-hoc Tukey test; normal vs. each group;

^‡ MD=mean deviation;

^§ PSD=patter standard deviation;

^П OHT=ocular hypertension.

Table 2.

The peripapillary retinal nerve fiber layer thickness of the study populations

Peri- papillary RNFL^‡ thickness	Normal (n=40 eyes)	OHT^§(n=30)	Pre-perimetric (n=30)	Early defect (n=30)	Moderate defect (n=30)	Severe defect (n=30)	p^*
Superior (µm)	114.6±20.9	110.5±15.7 p=0.245^†	105.6±15.5 p=0.153^†	86.9±15.6 p<0.001^†	82.3±12.6 p<0.001^†	76.4±19.3 p<0.001^†	<0.001
Inferior (µm)	124.2±18.8	119.8±14.8 p=0.352^†	99.6±12.2 p<0.001^†	91.8±20.4 p<0.001^†	71.5±19.9 p<0.001^†	61.5±20.8 p<0.001^†	<0.001
Nasal (µm)	69.1±14.1	67.9±10.5 p=0.456^†	57.9±13.6 p<0.001^†	60.6±10.7 p=0.028^†	70.8±12.5 p<0.001^†	50.1±9.1 p<0.001^†	<0.001
Temporal (µm)	70.1±7.4	67.4±9.3 p=0.273^†	61.9±12.4 p=0.011^†	57.9±13.6 p<0.001^†	52.2±11.9 p=0.035^†	48.1±14.1 p<0.001^†	<0.001
Mean (µm)	94.5±12.4	90.4±11.2 p=0.237^†	77.1±19.1 p=0.001^†	74.6±9.2 p<0.001^†	70.1±9.5 p<0.001^†	59.3±11.6 p<0.001^†	<0.001

^* p=ANOVA;

^† Analysis of variance with post-hoc Tukey test; normal vs. each group;

^‡ RNFL=retinal nerve fiber layer;

^§ OHT=ocular hypertension.

Table 3.

The macular thickness in normal, OHT, pre-perimetric glaucoma, open angle glaucoma (early, moderate, severe defect) groups

Macular thickness (MT)(µm)	Normal (n=40 eyes)	OHT^§(n=30)	Pre-perimetric (n=30)	Early defect (n=30)	Moderate defect (n=30)	Severe defect (n=30)	p^*
fovea (µm)	157.5±19.7	152.1±14.2 p=0.436^‡	156.5±23.1 p=0.881^‡	152.7±18.9 p=0.221^‡	154.9±16.1 p=0.472^‡	151.0±17.9 p=0.278^‡	0.597
1 mm (µm)	192.1±19.5	182.7±15.2 p=0.181^‡	187.9±16.7 p=0.485^‡	176.9±14.2 p=0.005^†	178.4±13.2 p=0.014^†	177.6±13.7 p=0.011^†	0.006
Superior (3 mm)(µm)	268.2±11.9	263.6±12.2 p=0.250^‡	259.8±10.3 p=0.027^†	245.9±15.6 p<0.001^†	256.1±16.1 p=0.006^†	235.9±34.2 p<0.001^†	<0.001
Inferior (3 mm)(µm)	268.2±12.1	263.8±18.1 p=0.292^‡	250.9±10.3 p<0.001^†	247.5±19.3 p<0.001^†	245.4±12.5 p<0.001^†	224.0±17.3 p<0.001^†	<0.001
Nasal (3 mm)(µm)	272.4±12.5	265.9±11.4 p=0.143^‡	258.1±12.3 p=0.001^†	250.0±17.9 p<0.001^†	259.8±14.1 p<0.001^†	243.6±26.9 p<0.001^†	<0.001
Temporal (3 mm)(µm)	258.4±12.4	254.4±16.7 p=0.349^‡	252.3±11.1 p=0.126^†	241.5±15.1 p<0.001^†	236.5±14.5 p<0.001^†	224.6±14.5 p<0.001^†	<0.001
Superior (6 mm)(µm)	235.9±14.0	237.8±12.0 p=0.736^‡	225.1±14.8 p=0.023^†	218.5±15.5 p<0.001^†	216.4±14.0 p<0.001^†	207.8±8.8 p<0.001^†	<0.001
Inferior (6 mm)(µm)	220.9±11.8	222.0±18.1 p=0.785^‡	202.4±16.1 p=0.023^†	200.3±14.3 p<0.001^†	197.5±11.5 p<0.001^†	185.9±14.2 p<0.001^†	<0.001
Nasal (6 mm)(µm)	250.0±13.8	248.5±11.4 p=0.763^‡	233.5±15.7 p=0.001^†	231.1±19.4 p<0.001^†	230.1±13.5 p<0.001^†	205.7±26.2 p<0.001^†	<0.001
Temporal (6 mm)(µm)	219.5±12.6	217.7±14.1 p=0.785^‡	207.7±12.2 p=0.005^†	204.0±10.1 p<0.001^†	201.3±10.1 p<0.001^†	186.8±11.5 p<0.001^†	<0.001
Mean MT (µm)	242.8±10.1	238.6±11.3 p=0.349^‡	230.9±10.9 p=0.001^†	224.0±14.1 p<0.001^†	224.6±9.8 p<0.001^†	210.2±15.1 p<0.001^†	<0.001

^* p=ANOVA;

^† p<0.05, Analysis of variance with post-hoc Tukey test; normal vs. each group;

^‡ p>0.05, Analysis of variance with post-hoc Tukey test; normal vs. each group;

^§ OHT=ocular hypertension.

Table 4.

Correlation between MD, PSD and macular thickness in 190 eyes

Macular thickness	Pearson correlation coefficient (MD^†)	Pearson correlation coefficient (PSD^‡)
fovea	0.048 (p=0.635^*)	-0.010 (p=0.917^*)
1 mm	0.009 (p=0.933^*)	-0.050 (p=0.610^*)
Superior (3 mm)	0.279 (p=0.005^*)	-0.422 (p<0.001^*)
Inferior (3 mm)	0.353 (p<0.001^*)	-0.483 (p<0.001^*)
Nasal (3 mm)	0.270 (p=0.005^*)	-0.322 (p=0.001^*)
Temporal (3 mm)	0.449 (p<0.001^*)	-0.599 (p<0.001^*)
Superior (6 mm)	0.483 (p<0.001^*)	-0.602 (p<0.001^*)
Inferior (6 mm)	0.420 (p<0.001^*)	-0.507 (p<0.001^*)
Nasal (6 mm)	0.363 (p<0.001^*)	-0.492 (p<0.001^*)
Temporal (6 mm)	0.490 (p<0.001^*)	-0.600 (p<0.001^*)
Mean macular thickness	0.513 (p<0.001^*)	-0.596 (p<0.001^*)

^* Correlation analysis: Pearson correlation;

^† MD=mean deviation;

^‡ PSD=pattern standard deviation.

Table 5.

Correlation between MD, PSD and RNFL thickness in 190 eyes

RNFL thickness	Pearson correlation coefficient (MD^†)	Pearson correlation coefficient (PSD^‡)
Superior	0.579 (p<0.001^*)	-0.524 (p<0.001^*)
Inferior	0.374 (p<0.001^*)	-0.392 (p<0.001^*)
Nasal	0.399 (p<0.001^*)	-0.291 (p<0.001^*)
Lateral	0.485 (p<0.001^*)	-0.485 (p<0.001^*)
Mean RNFL^§	0.554 (p<0.001^*)	-0.492 (p<0.001^*)

^* Correlation analysis: Pearson correlation;

^† MD=mean deviation;

^‡ PSD=pattern standard deviation;

^§ RNFL=retinal nerve fiber layer.

Table 6.

Comparison of superior and inferior inner, outer macular thickness, retinal nerve fiber layer thickness in open angle glaucoma 20 eyes with unilateral (superior only) visual field defect

	MT^† superior (3 mm)(µm)	MT inferior (3 mm)(µm)	p^*
Superior VF^‡ defect(n=20)	245.70±25.26	223.40±14.52	0.026
	MT superior (6 mm)(µm)	MT inferior (6 mm)(µm)	p^*
Superior VF defect(n=20)	208.30±15.56	179.50±10.45	<0.001
	RNFL superior (µm)	RNFL inferior (µm)	p^*
Superior VF defect(n=20)	88.90±9.54	65.90±15.95	0.001

^* p=ANOVA;

^† MT=macular thickness;

^‡ VF=visual field.

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