Analysis of Factors Related of Location of Initial Visual Field Defect in Normal Tension Glaucoma

Byung Wan Kang; Yong Sok Ji; Sang Woo Park

doi:10.3341/jkos.2011.52.12.1478

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Kang, Ji, and Park: Analysis of Factors Related of Location of Initial Visual Field Defect in Normal Tension Glaucoma

Original Article

J Korean Ophthalmol Soc 2011;52(12):1478-1484.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.12.1478

Analysis of Factors Related of Location of Initial Visual Field Defect in Normal Tension Glaucoma

Byung Wan Kang, MD, Yong Sok Ji, MD, Sang Woo Park, MD, PhD

Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea

Address reprint requests to Sang Woo Park, MD, PhD Department of Ophthalmology, Chonnam National University Hospital #42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: Exo70@naver.com

Received 4 March 20119 May 2011 Accepted 18 October 2011

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 risk factors related to the location of visual field defects in normal tension glaucoma.

Methods

Eighty-one eyes diagnosed as normal tension glaucoma in patients with early glaucomatous visual field defects were divided into central visual field defects and peripheral visual field defects. The difference between the 2 groups based on the intra-individual comparison were assessed with several ocular risk factors such as sex, age, hypertension, diabetes mellitus, smoking, laterality, intraocular pressure, central corneal thickness, cup-disc ratio, peripapillary atrophy, mean deviation, pattern standard deviation, best corrected visual acuity, and refractive errors.

Results

The incidence of hypertension in the central visual field defects group (60.6%) was higher than in the peripheral visual field defects group (22.9%, p = 0.001). The central corneal thickness in the central group (533.1 ± 18.2 μ m) was thin-ner than in the peripheral group (545.0 ± 30.0 μ m, p = 0.003). Hypertension was the only risk factors for central visual field defects (p = 0.001). In both the central group and peripheral group, upper visual field defects were more common than lower defects.

Conclusions

Hypertension in patients with normal tension glaucoma was a factor involved in central visual field defects. Additionally, numerous visual field defects were mainly found the superior portion.

Keywords: Hypertension, Normal tension glaucoma, Visual field defect

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Figure 1.

Visual field probability plot (pattern deviation) divided into 4 subfields: a central 10 degree (radius) and outer arcu-ate subfields in both superior and inferior hemifields (left eye).

Figure 2.

Examples of visual field defect evaluation on visual field gray scale and pattern deviation scale (A, B) Central field defects, (C, D) Peripheral field defects. GHT = glaucoma hemifield test.

Table 1.

Demographics and characteristics of patients with normal tension glaucoma

	Central scotoma	Peripheral scotoma	p-value
Number of patients	33	48
Sex (M/F)	12/21	26/22	0.174^∗
Age (yr)	60.2 ± 10.6	59.0 ± 10.2	0.621^†
Hypertension	20	11	0.001^∗
Diabetes mellitus	7	11	1.000^∗
Smoking	9	13	1.000^∗
Laterality (Rt/Lt)	22/11	23/25	0.115^∗
Intraocular pressure (mm Hg)	14.5 ± 2.4	14.7 ± 2.8	0.739^†
Central corneal thickness (μ m)	533.1 ± 18.2	545.0 ± 30.0	0.030^†
Mean deviation of visual field (dB)	‐3.62 ± 1.96	‐4.14 ± 2.92	0.343^†
Pattern standard deviation of visual field (dB)	4.27 ± 2.49	5.10 ± 2.67	0.164^†
Cup disc ratio	0.72 ± 0.12	0.71 ± 0.11	0.732^†
β zone area of peripapillary atrophy (mm²)	0.62 ± 0.86	0.56 ± 0.81	0.730^†
Visual acuity (log MAR)	0.07 ± 0.15	0.06 ± 0.12	0.747^†
Refractive errors (spherical equivalent, diopter)	‐0.42 ± 1.65	‐0.35 ± 1.70	0.837^†

Values are presented as mean ± SD or number.

^∗ Fisher's exact test

^† Student's t-test.

Table 2.

The risk factors for central field defects in normal tension glaucoma

Univariate analysis of factors affecting central field defect
Prognostic factor	Odd ratio	95% C.I.	p-value
Sex
Male	1		0.117
Female	2.07	(0.83, 5.13)
Age	1.01	(0.97, 1.06)	0.613
Hypertension
Yes	1		0.001
No	0.19	(0.07, 0.51)
Diabetes mellitus
Yes	1		0.856
No	1.10	(0.38, 3.22)
Current smoker
Yes	1		0.985
No	0.99	(0.37, 2.68)
Laterality
Right	1		0.767
Left	0.77	(0.32, 1.87)
Intraocular pressure	0.97	(0.82, 1.15)	0.743
Central corneal thickness	0.98	(0.96, 1.00)	0.054
Mean deviation	1.08	(0.91, 1.29)	0.375
Pattern standard deviation	0.87	(0.72, 1.06)	0.169
Cup disc ratio	2.08	(0.04, 2.89)	0.722
β zone area of peripapillary atrophy	1.10	(0.65, 1.88)	0.724
Visual acuity (log MAR)	1.80	(0.06, 50.5)	0.731
Refractive errors (spherical equivalent, diopter)	1.03	(0.72, 1.47)	0.859

Table 3.

Number (percentage) of abnormal points in subfields

	Total number of points in subfields	Number (%) of abnormal points
Superior, central	198 (6 × 33)	76 (38.4)
Inferior, central	198 (6 × 33)	50 (25.3)
p-value^∗		0.007
Superior, peripheral	1488 (31 × 48)	251 (16.9)
Inferior, peripheral	1488 (31 × 48)	188 (12.6)
p-value^∗		0.001

^∗ Chi-square test.

Table 4.

Number (percentage) of abnormal clusters in subfields

	Total number of clusters in subfields	Number (%) of abnormal clusters
Superior, central	66 (2 × 33)	13 (19.7)
Inferior, central	66 (2 × 33)	11 (16.7)
p-value^∗		0.132
Superior, peripheral	480 (10 × 48)	61 (12.7)
Inferior, peripheral	480 (10 × 48)	50 (10.4)
p-value^∗		0.313

^∗ Chi-square test.

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