RNFL and Ganglion Cell Complex Thickness in Normal Hemifield According to the Severity of Glaucoma

Eun Hee Hong; Yong Un Shin; Han Woong Lim; Min Ho Kang; Hee Yoon Cho; Mincheol Seong

doi:10.3341/jkos.2016.57.4.614

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Hong, Shin, Lim, Kang, Cho, and Seong: RNFL and Ganglion Cell Complex Thickness in Normal Hemifield According to the Severity of Glaucoma

Original Article

J Korean Ophthalmol Soc 2016;57(4):614-622.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.4.614

RNFL and Ganglion Cell Complex Thickness in Normal Hemifield According to the Severity of Glaucoma

Eun Hee Hong, MD, Yong Un Shin, MD, PhD, Han Woong Lim, MD, PhD, Min Ho Kang, MD, PhD, Hee Yoon Cho, MD, PhD, Mincheol Seong, MD, PhD

Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea

Address reprint requests to Mincheol Seong, MD, PhD Department of Ophthalmology, Hanyang University Guri Hospital, #153 Gyeongchun-ro, Guri 11923, Korea Tel: 82-31-560-2354, Fax: 82-31-564-9479 E-mail: goddns76@hanmail.net

Received 10 December 2015 Revised 24 February 2016 Accepted 21 March 2016

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 analyze the thickness of the circumpapillary retinal nerve fiber layer (cRNFL) and macular ganglion cell complex (mGCC) in apparently normal hemifield areas of glaucomatous eyes with superior or inferior visual hemifield defects according to their severity compared with the same hemifield of normal eyes using Topcon 3D spectral-domain optical coherence tomography (SD-OCT).

Methods

The present study included 90 normal eyes and 90 glaucomatous eyes with superior or inferior visual hemifield defects that underwent cRNFL and mGCC imaging using 3D SD-OCT. The cRNFL and mGCC parameters were compared between normal hemifield in glaucomatous eyes and the same hemifield in normal eyes. The mean deviation (MD) parameters (Mild: MD > −6 dB, 54 eyes; Moderate: −6 dB ≥ MD ≥ −12 dB, 60 eyes; Severe: MD < −12 dB, 30 eyes) in glaucomatous eyes were also compared between the 3 severity groups.

Results

The average hemifield cRNFL thickness was 93.6 ± 24.2 µm and 118.1 ± 14.1 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 107.8 ± 19.1 µm and 124.9 ± 17.1 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively. mGCC thickness was 95.8 ± 5.9 µm and 103.5 ± 7.7 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 93.4 ± 8.2 µm and 104.5 ± 8.2 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively (all p < 0.05). The thickness parameters were decreased in normal hemifield of glaucomatous eyes, which significantly decreased according to the severity (MD) of visual field defect (all p < 0.01).

Conclusions

The measurement of cRNFL and mGCC thickness in normal hemifield of glaucomatous eyes using SD-OCT is useful in detecting structural glaucomatous changes before visual field defects appear.

Keywords: Circumpapillary retinal nerve fiber layer (cRNFL), Glaucoma, Hemifield defect, Macular ganglion cell complex (mGCC), Spectral-domain optical coherence tomography (SD-OCT)

References

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Table 1.

Descriptive statistics for demographics and clinical characteristics of the study participants

	Glaucoma (n = 90)	Control (n = 90)	p-value^*
Gender (male/female)	44/46	52/38	0.232^*
Age (years)	61.0 ± 12.6	58.6 ± 7.92	0.136^†
Eye (OD/OS)	41/49	56/34	0.591^*
Superior/Inferior	43/47	−	−
MD (dB)	−8.44 ± 5.09	0.58 ± 0.63	<0.001^†
PSD (dB)	9.15 ± 5.20	1.64 ± 0.26	<0.001^†

Values are presented as mean ± SD unless otherwise indicated.

MD = mean deviation; PSD = pattern standard deviation.

^* Chi-square test;

^† Independent t-test.

Table 2.

Spectrum-domain optical coherence tomography data of the cRNFL thickness and macular ganglion cell complex (mGCC; NFL, IPL+GCL, NFL+ IPL+GCL) thickness parameters in glaucomatous and control eyes

	Glaucoma (n = 90)	Control (n=90)	p-value^*
cRNFL parameters (μm)
Average thickness	79.7 ± 14.3	99.6 ± 11.5	<0.001
Superior thickness	83.8 ± 26.6	118.1 ± 14.1	<0.001
Inferior thickness	90.6 ± 27.3	124.9 ± 17.1	<0.001
mGCC NFL parameters (μm)
Average thickness	26.6 ± 6.83	34.7 ± 4.01	<0.001
Superior thickness	28.0 ± 7.83	33.5 ± 3.77	<0.001
Inferior thickness	25.2 ± 10.6	36.0 ± 5.02	<0.001
mGCC IPL + GCL parameters (μm)
Average thickness	61.5 ± 5.60	69.4 ± 4.95	<0.001
Superior thickness	62.8 ± 6.07	70.4 ± 5.15	<0.001
Inferior thickness	60.3 ± 4.91	68.6 ± 4.97	<0.001
mGCC NFL + IPL + GCL parameters (μm)
Average thickness	88.4 ± 11.2	104.0 ± 7.65	<0.001
Superior thickness	90.2 ± 12.3	103.5 ± 7.66	<0.001
Inferior thickness	86.2 ± 14.0	104.5 ± 8.20	<0.001

Values are presented as mean ± SD unless otherwise indicated.

cRNFL = circumpapillary retinal nerve fiber layer; mGCC = macular ganglion cell complex; NFL = nerve fiber layer; IPL = inner plexiform layer; GCL = ganglion cell layer.

^* Independent t-test.

Table 3.

Comparison of cRNFL thickness and mGCC (NFL, IPL + GCL, NFL + IPL + GCL) thickness parameters in superior and inferior hemiretina with hemifield defect and normal field and control eyes

	Hemiretina with a hemifield defect	Hemiretina with normal field	Hemiretina of control eye	p-value
cRNFL parameters (μm)
Superior	74.1 ± 27.3	93.6 ± 24.2 (n = 43)	118.1 ± 14.1	<0.001^*, <0.001^†
Inferior	74.7 ± 25.7	107.8 ± 19.1 (n = 47)	124.9 ± 17.1	<0.001^*, <0.001^†
mGCC NFL parameters (μm)
Superior	19.1 ± 11.5	31.7 ± 5.56 (n = 43)	33.5 ± 3.77	<0.001^*, 0.024^†
Inferior	24.7 ± 8.17	30.8 ± 5.53 (n = 47)	36.0 ± 5.02	<0.001^*, <0.001^†
mGCC IPL + GCL parameters (μm)
Superior	58.3 ± 5.19	63.9 ± 3.51 (n = 43)	70.4 ± 5.15	<0.001^*, <0.001^†
Inferior	61.8 ± 7.61	62.3 ± 3.78 (n = 47)	68.6 ± 4.97	<0.001^*, <0.001^†
mGCC NFL + IPL + GCL parameters (μm)
Superior	78.4 ± 14.8	95.8 ± 5.90 (n = 43)	103.5 ± 7.66	<0.001^*, <0.001^†
Inferior	85.0 ± 14.4	93.4 ± 8.20 (n = 47)	104.5 ± 8.20	<0.001^*, <0.001^†

Values are presented as mean ± SD unless otherwise indicated.

cRNFL = circumpapillary retinal nerve fiber layer; mGCC = macular ganglion cell complex; NFL = nerve fiber layer; IPL = inner plexiform layer; GCL = ganglion cell layer.

^* Hemiretina with a hemifield defect vs. Hemiretina with normal field; paired t-test;

^† Hemiretina with normal field vs Control; independent t-test.

Table 4.

Correlation between cRNFL and mGCC (NFL, IPL + GCL, NFL + IPL + GCL) thickness parameters and glaucoma severity values in hemiretina with hemiefield defect and normal field, respectively

	MD		PSD
	R²	p-value^*	R²	p-value^*
cRNFL parameters (μm)
Defected hemifield	0.451	<0.001	0.354	<0.001
Normal hemifield	0.227	<0.001	0.183	<0.001
mGCC NFL parameters (μm)
Defected hemifield	0.430	<0.001	0.421	<0.001
Normal hemifield	0.085	0.005	0.039	0.064
mGCC IPL + GCL parameters (μm)
Defected hemifield	0.100	0.002	0.041	0.055
Normal hemifield	0.119	0.001	0.031	0.096
mGCC NFL + IPL + GCL parameters (μm)
Defected hemifield	0.357	<0.001	0.277	<0.001
Normal hemifield	0.091	0.004	0.030	0.103

cRNFL = circumpapillary retinal nerve fiber layer; mGCC = macular ganglion cell complex; NFL = nerve fiber layer; IPL = inner plexiform layer; GCL = ganglion cell layer; MD = mean deviation; PSD = pattern standard deviation.

^* Linear regression.

Table 5.

Comparison of cRNFL and mGCC (NFL, IPL + GCL, NFL + IPL + GCL) thickness parameters between glaucoma severity groups (mild, moderate and severe groups) according to MD value in hemiretina with hemifield defect and normal field, respectively

	Severity group (according to MD)			p-value^*
	Mild	Moderate	Severe	p-value^*
cRNFL parameters (μm)
Defected hemifield	95.2 ± 21.6	73.6 ± 20.7	54.5 ± 19.8	<0.001
Normal hemifield	111.7 ± 19.9	102.7 ± 19.1	88.4 ± 23.2	<0.001
mGCC NFL parameters (μm)
Defected hemifield	30.5 ± 6.86	20.8 ± 8.70	14.8 ± 8.42	<0.001
Normal hemifield	33.3 ± 5.30	31.2 ± 3.63	29.1 ± 6.61	0.013
mGCC IPL + GCL parameters (μm)
Defected hemifield	62.6 ± 5.65	59.5 ± 5.99	58.3 ± 7.92	0.037
Normal hemifield	64.7 ± 3.60	62.8 ± 4.00	61.7 ± 2.96	0.005
mGCC NFL + IPL + GCL parameters (μm)
Defected hemifield	92.4 ± 10.0	81.6 ± 13.0	71.7 ± 13.6	<0.001
Normal hemifield	97.5 ± 8.32	94.0 ± 6.60	92.1 ± 5.75	0.012

Values are presented as mean ± SD unless otherwise indicated.

cRNFL = circumpapillary retinal nerve fiber layer; mGCC = macular ganglion cell complex; NFL = nerve fiber layer; IPL = inner plexiform layer; GCL = ganglion cell layer; MD = mean deviation.

^* One-way analysis of variance (ANOVA).

Table 6.

		Severity group (according to MD)
		Mild	Moderate	Severe
cRNFL parameters (μm)
Control group sup. field	118.1 ± 14.1
Normal hemifield sup. field	93.6 ± 24.2 (n = 43)	107.2 ± 22.6 (n = 13)	96.0 ± 16.6 (n = 13)	81.4 ± 25.2 (n = 17)
p-value^*	<0.001	0.025	<0.001	<0.001
Control group inf. field	124.9 ± 17.1
Normal hemifield inf. field	107.8 ± 19.1 (n = 47)	110.1 ± 8.96 (n = 17)	107.9 ± 19.7 (n = 17)	97.5 ± 17.1 (n = 13)
p-value^*	<0.001	0.005	0.029	<0.001
mGCC NFL parameters (μm)
Control group sup. field	33.5 ± 3.77
Normal hemifield sup. field	31.7 ± 5.56 (n = 43)	33.5 ± 3.62 (n = 13)	31.2 ± 2.71 (n = 13)	30.6 ± 7.84 (n = 17)
p-value^*	0.024	0.994	0.035	0.016
Control group inf. field	36.0 ± 5.02
Normal hemifield inf. field	30.8 ± 5.53 (n = 47)	33.1 ± 6.40 (n = 17)	31.2 ± 4.29 (n = 17)	27.3 ± 4.14 (n = 13)
p-value^*	<0.001	0.043	<0.001	<0.001
mGCC IPL + GCL parameters (μm)
Control group sup. field	70.4 ± 5.15
Normal hemifield sup. field	63.9 ± 3.51 (n = 43)	65.0 ± 3.70 (n = 13)	64.4 ± 3.64 (n = 13)	62.8 ± 3.10 (n = 17)
p-value^*	<0.001	<0.001	<0.001	<0.001
Control group inf. field	68.6 ± 4.97
Normal hemifield inf. field	62.3 ± 3.78 (n = 47)	64.5 ± 3.63 (n = 17)	61.5 ± 3.92 (n = 17)	60.2 ± 2.11 (n = 13)
p-value^*	<0.001	0.002	<0.001	<0.001
mGCC NFL + IPL + GCL parameters (μm)
Control group sup. field	103.5 ± 7.66
Normal hemifield sup. field	95.8 ± 5.90 (n = 43)	98.1 ± 6.26 (n = 13)	95.7 ± 5.28 (n = 13)	94.2 ± 5.84 (n = 17)
p-value^*	<0.001	0.017	0.001	<0.001
Control group inf. field	104.5 ± 8.20
Normal hemifield inf. field	93.4 ± 8.20 (n = 47)	97.1 ± 9.78 (n = 17)	92.8 ± 7.37 (n = 17)	89.4 ± 4.50 (n = 13)
p-value^*	<0.001	0.001	<0.001	<0.001

Values are presented as mean ± SD unless otherwise indicated.

^* Independent t-test.

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