Comparison Between Retinal Nerve Fiber Layer Change and Visual Field Change in Normal Tension Glaucoma

Won Hyuk Lee; Mi Sun Sung; Jun Woo Shin; Joo Hwa Lee

doi:10.3341/jkos.2010.51.12.1606

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Lee, Sung, Shin, and Lee: Comparison Between Retinal Nerve Fiber Layer Change and Visual Field Change in Normal Tension Glaucoma

Original Article

J Korean Ophthalmol Soc 2010;51(12):1606-1613.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.12.1606

Comparison Between Retinal Nerve Fiber Layer Change and Visual Field Change in Normal Tension Glaucoma

Won Hyuk Lee, MD, Mi Sun Sung, MD, Jun Woo Shin, MD, Joo Hwa Lee, MD

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

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

Received 8 April 2010 Accepted 10 November 2010

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 evaluate longitudinal changes in retinal nerve fiber layer thickness (RNFL) and visual field in patients with normal tension glaucoma (NTG).

Methods

Thirty eyes of 30 NTG patients and 30 eyes of 30 normal control subjects were enrolled in the present study. RNFL thickness was measured using optical coherence tomography (OCT), and visual field tests were performed using a Humphrey visual field analyzer at baseline and 23.3 ± 15.3 months later. Changes in RNFL thickness at each clock-hour segment and visual field sensitivities were analyzed. The rates of change in RNFL thickness were also calculated.

Results

Significant differences in RNFL thickness were observed between NTG patients and normal control subjects at the 5, 6, 7 and 12 o'clock positions at baseline (p < 0.001). At follow-up, the RNFL thickness change was not significant for normal control subjects, although it was significant for NTG patients at the 4, 5, 6, 7, 11 and 12 o'clock positions (p < 0.001). Visual field parameters did not change significantly in the normal control subjects or NTG patients. The reduction rates of RNFL thickness were 0.38 μ m/month for the NTG patients and 0.11 μ m/month for the normal control group, displaying a 3.5-fold faster reduction rate for NTG patients.

Conclusions

The NTG group showed greater reductions in RNFL thickness in the upper and lower sectors over time; however, the visual field parameters did not change significantly. The results suggest that progression of glaucoma can be detected in an earlier stage using OCT than can be detected using a visual field test.

Keywords: Longitudinal study, Normal tension glaucoma, Optical coherence tomography, Retinal nerve fiber layer thickness, Visual field test

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Figure 1.

Distribution of visual field (VF) zones and associated short-wavelength automated perimetry test points relative to temporal (T) and nasal (N) retinal positions. Odd-numbered VF zones are shaded gray.

Figure 2.

Optical coherence tomography 30-degree sectors in a clock hour distribution relative to temporal (T) and nasal (N) retinal positions.

Table 1.

Patient characteristics

	Study subjects (n = 60) (mean ± standard deviation)
	Control (n = 30)	NTG^* (n = 30)	p value^†
Male/Female	30 (14/16)	30 (13/17)	0.332
Age (yr)	41.4 ± 16.1	45.2 ± 12.7	0.203
Refractive error (D sph)	−1.211 ± 1.101	−1.411 ± 2.911	0.354
IOP^‡ (mmHg)	13.8 ± 2.3	14.1 ± 2.6	0.553
Follow up (mon)	20.74 ± 15.22	25.88 ± 15.90	0.364
Frequency of OCT^§	2.83 ± 0.74	3.13 ± 0.93	0.391
Frequency of VF^∏	2.93 ± 0.89	3.03 ± 0.85	0.372
Cup/Disc ratio	0.28 ± 0.08	0.67 ± 0.16	<0.01
Mean deviation (MD)	−3.13 ± 2.37	−7.92 ± 6.83	<0.01
Pattern standard deviation (PSD)	1.91 ± 0.52	6.99 ± 4.85	<0.01

^* NTG = normal tension glaucoma

^† p value = Unpaired t-test

^‡ IOP = intraocular pressure

^§ OCT = optical coherence tomography

^∏ VF = visual field.

Table 2.

Baseline retinal nerve fiber layer thickness (μ m) of control and NTG

Clock hour position (o'clock)	Mean ± standard deviation (μ m)		p value^†
Clock hour position (o'clock)	Control group	NTG^* group	p value^†
1	105.50 ± 40.51	100.20 ± 24.65	0.596
2	75.79 ± 24.06	79.90 ± 15.13	0.561
3	52.14 ± 12.84	58.13 ± 10.37	0.134
4	61.86 ± 20.19	62.93 ± 11.10	0.853
5	95.57 ± 23.19	80.40 ± 20.12	0.041
6	128.79 ± 36.50	95.83 ± 28.95	0.050
7	123.93 ± 28.47	97.77 ± 36.74	0.013
8	66.93 ± 21.32	65.07 ± 20.44	0.786
9	54.64 ± 12.08	56.33 ± 12.13	0.668
10	74.21 ± 26.07	75.20 ± 14.70	0.896
11	118.36 ± 27.95	103.47 ± 23.12	0.090
12	122.57 ± 23.08	100.83 ± 29.61	0.011
Total	90.11 ± 17.11	81.34 ± 16.26	0.116

^* NTG = normal tension glaucoma

^† p value = Unpaired t-test.

Table 3.

Baseline visual field parameter of control and NTG

Visual field zone	Mean ± standard deviation		p value^†
Visual field zone	Control group	NTG^* group	p value^†
1	−1.29 ± 2.23	−1.80 ± 3.63	0.629
2	−1.21 ± 1.31	−3.83 ± 6.20	0.034
3	−1.46 ± 0.77	−3.52 ± 6.76	0.111
4	−1.45 ± 0.82	−4.44 ± 6.70	0.022
5	−2.29 ± 1.16	−5.08 ± 6.05	0.021
6	−1.83 ± 0.84	−4.61 ± 6.23	0.023
7	−1.82 ± 0.94	−5.71 ± 8.98	0.026
8	−1.97 ± 1.33	−7.27 ± 8.97	0.003
9	−1.29 ± 1.64	−4.73 ± 9.40	0.060
10	−1.00 ± 0.96	−1.47 ± 3.72	0.648
11	0	0	
12	−1.07 ± 0.92	−3.80 ± 7.92	0.208
13	−1.79 ± 1.48	−4.33 ± 8.60	0.125
14	−2.16 ± 1.32	−7.30 ± 8.21	0.002
15	−1.88 ± 0.73	−6.68 ± 8.31	0.004
16	−1.79 ± 0.81	−7.43 ± 8.80	0.002
17	−1.73 ± 1.20	−7.06 ± 7.23	<0.001
18	−1.50 ± 2.34	−7.38 ± 8.06	0.001
19	−1.29 ± 1.33	−5.78 ± 7.49	0.003
20	−0.93 ± 1.44	−3.37 ± 5.35	0.026
21	−0.64 ± 1.78	−2.97 ± 5.35	0.122
MD^‡	−2.81± 1.87	−7.93 ± 6.83	0.001
PSD^§	1.92 ± 0.52	6.99 ± 4.85	<0.001

^* NTG = normal tension glaucoma

^† p value = Unpaired t-test

^‡ MD = mean deviation

^§ PSD = pattern standard deviation.

Table 4.

Changes in retinal nerve fiber layer thickness (μ m) for control and NTG (mean ± standard deviation)

Clock hour position (o'clock)	Control (20.74 ± 15.22 months follow up)			NTG^* (25.88 ± 15.90 months follow up)
Clock hour position (o'clock)	Baseline	Follow up	p value^†	Baseline	Follow up	p value^†
1	105.50 ± 24.65	107.93 ± 22.64	0.414	100.20 ± 40.51	95.30 ± 40.20	0.225
2	75.79 ± 15.13	79.64 ± 12.53	0.223	79.90 ± 24.06	74.97 ± 25.92	0.079
3	52.14 ± 10.37	54.79 ± 11.46	0.498	58.13 ± 12.84	52.53 ± 17.07	0.069
4	61.86 ± 11.10	61.57 ±10.63	0.941	62.93 ± 20.19	56.37 ± 18.79	0.021
5	95.57 ± 20.12	96.79 ± 18.66	0.730	80.40 ± 23.19	69.83 ± 23.52	0.019
6	128.79 ± 28.95	132.29 ± 25.20	0.242	95.83 ± 36.50	84.63 ± 33.88	0.008
7	123.93 ± 36.74	119.86 ± 31.10	0.285	97.77 ± 28.47	86.30 ± 24.73	0.001
8	66.93 ± 20.44	63.50 ± 20.95	0.122	65.07 ± 21.32	63.53 ± 22.27	0.402
9	54.64 ± 12.13	52.57 ± 12.25	0.348	56.33 ± 12.08	55.03 ± 13.44	0.604
10	74.21 ± 14.70	72.29 ± 13.24	0.377	75.20 ± 26.07	74.10 ± 26.30	0.510
11	118.36 ± 23.12	110.93 ± 24.55	0.198	103.47 ± 27.95	97.20 ± 32.47	0.011
12	122.57 ± 29.61	119.21 ± 27.02	0.417	100.83 ± 23.08	90.30 ± 24.34	0.001
Total	90.11 ± 16.26	89.27 ± 14.42	0.697	81.34 ± 17.11	75.10 ± 16.09	<0.001

^* NTG = normal tension glaucoma.

^† p value = Paired t-test.

Table 5.

Changes in visual fields parameters (db) for control and NTG (mean ± standard deviation)

Zone (o'clock)	Control (20.74 ± 15.22 months follow-up)			NTG^* (25.88 ± 15.90 months follow-up)
Zone (o'clock)	Baseline	Follow-up	p value^†	Baseline	Follow up	p value^†
1	−1.29 ± 2.23	−4.21 ± 7.86	0.128	−1.80 ± 3.63	−1.77 ± 2.56	0.965
2	−1.21 ± 1.31	−2.29 ± 2.16	0.037	−3.83 ± 6.20	−2.70 ± 4.50	0.145
3	−1.46 ± 0.77	−1.61 ± 1.48	0.755	−3.52 ± 6.76	−3.48 ± 4.70	0.958
4	−1.45 ± 0.82	−2.60 ± 1.90	0.028	−4.44 ± 6.70	−4.62 ± 7.02	0.773
5	−2.29 ± 1.16	−3.12 ± 1.77	0.072	−5.08 ± 6.05	−6.37 ± 7.41	0.034
6	−1.83 ± 0.84	−1.64 ± 1.48	0.657	−4.61 ± 6.23	−5.94 ± 8.06	0.068
7	−1.82 ± 0.94	−1.73 ± 1.20	0.797	−5.71 ± 8.98	−6373 ± 9.37	0.207
8	−1.97 ± 1.33	−1.69 ± 0.89	0.411	−7.27 ± 8.97	−7.47 ± 8.92	0.733
9	−1.29 ± 1.64	−1.50 ± 1.91	0.711	−4.73 ± 9.40	−6.27 ± 10.13	0.327
10	−1.00 ± 0.96	−1.39 ± 1.76	0.518	−1.47 ± 3.72	−2.17 ± 3.43	0.099
11	0	0		0	0	
12	−1.07 ± 0.92	−2.29 ± 1.64	0.023	−3.80 ± 7.92	−4.67 ± 7.95	0.271
13	−1.79 ± 1.48	−2.00 ± 1.30	0.690	−4.33 ± 8.60	−5.03 ± 7.68	0.430
14	−2.16 ± 1.32	−2.29 ± 1.77	0.815	−7.30 ± 8.21	−7.61 ± 7.69	0.675
15	−1.88 ± 0.73	−2.00 ± 1.42	0.705	−6.68 ± 8.31	−6.30 ± 7.46	0.700
16	−1.79 ± 0.81	−1.66 ± 1.32	0.751	−7.43 ± 8.80	−7.07 ± 7.92	0.674
17	−1.73 ± 1.20	−2.36 ± 3.03	0.373	−7.06 ± 7.23	−8.34 ± 6.84	0.213
18	−1.50 ± 2.34	−1.82 ± 2.18	0.644	−7.38 ± 8.06	−6.88 ± 6.81	0.658
19	−1.29 ± 1.33	−1.64 ± 1.75	0.502	−5.78 ± 7.49	−6.15 ± 6.57	0.706
20	−0.93 ± 1.44	−2.00 ± 4.66	0.289	−3.37 ± 5.35	−4.93 ± 6.58	0.126
21	−0.64 ± 1.78	−1.71 ± 2.05	0.073	−2.97 ± 5.35	−2.47 ± 3.50	0.554
MD^‡	−2.81± 1.87	−3.20 ± 2.76	0.902	−7.93 ± 6.83	−9.04 ± 7.46	0.055
PSD^§	1.92 ± 0.52	2.76 ± 1.90	0.064	6.99 ± 4.85	7.52 ± 4.74	0.272

^* NTG = normal tension glaucoma

^† p value = Paired t-test

^‡ MD = mean deviation

^§ PSD = pattern standard deviation.

Table 6.

Rate of changes in retinal nerve fiber layer thickness parameters (μ m/month) for control and NTG (mean ± standard deviation)

Clock hour position (o'clock)	Control (20.74 ± 15.22 months follow-up)	(25.88 ± 15.90 months follow-up NTG^*	) p value^†
1	−0.10 ± 0.75	−0.46 ± 0.11	0.01
2	−0.09 ± 0.65	−0.37 ± 0.10	0.02
3	−0.08 ± 0.58	−0.26 ± 0.09	<0.01
4	−0.09 ± 0.73	−0.27 ± 0.08	0.33
5	−0.09 ± 0.83	−0.37 ± 0.14	0.60
6	−0.11 ± 0.64	−0.45 ± 0.18	0.01
7	−0.11 ± 0.75	−0.49 ± 0.22	0.01
8	−0.11 ± 0.45	−0.31 ± 0.09	0.07
9	−0.09 ± 0.36	−0.26 ± 0.05	0.07
10	−0.08 ± 0.46	−0.37 ± 0.11	<0.01
11	−0.12 ± 0.80	−0.48 ± 0.17	0.03
12	−0.13 ± 0.87	−0.46 ± 0.10	0.02
Total	−0.11 ± 0.35	−0.38 ± 0.06	<0.01

^* NTG = normal tension glaucoma

^† p value = Unpaired t-test.

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