Retrobulbar Hemodynamics and Visual Field Progression in Normal Tension Glaucoma: A Long-Term Follow-Up Study.

PURPOSE: Vascular risk factors are important factors in the pathogenesis of glaucoma. The purpose of this research was to investigate retrobulbar hemodynamics and visual field progression in patients with normal tension glaucoma (NTG). PATIENTS AND METHODS: 31 eyes of 16 patients with NTG were included in a retrospective long-term follow-up study. Colour Doppler imaging was performed at baseline to determine various CDI parameters in the different retrobulbar vessels. The rate of visual field progression was determined using the Visual Field Index (VFI) progression rate per year (in %). To be included in the analysis, patients had at least 4 visual field examinations with a follow-up of at least 2 years. RESULTS: Mean follow-up was 7.6 ± 4.1 years with an average of 10 ± 5 visual field tests. The mean MD (mean defect) at baseline was -7.61 ± 7.49 dB. The overall VFI progression was -1.14 ± 1.40% per year. A statistical significant correlation between VFI progression and the RI of the NPCA and PSV of the CRA was found. CONCLUSION: Long-term visual field progression may be linked to impaired retrobulbar hemodynamics in patients with NTG only to a limited degree. Interpretation of the data for an individual patient seems to be limited due to the variability of parameters.

[Sensitivity and Specificity of the Nerve Fibre Imaging Using Scanning Laser Ophthalmoscopy and of Optic Nerve Analysis Using Heidelberg Retina Tomography in Glaucoma]. / Sensitivität und Spezifität der Nervenfaserdarstellung mittels Scanning-Laser-Ophthalmoskop und der quantitativen Sehnervenanalyse bei Glaukom.

PURPOSE: Imaging of the optic nerve head and the nerve fibre layer are used in the diagnosis of glaucoma. We have investigated the diagnostic precision of nerve fibre layer imaging using a manually operated scanning laser ophthalmoscope and analysis of the optic nerve head using the Heidelberg Retina Tomograph II (HRT). PATIENTS AND METHODS: 42 patients with glaucoma, 16 patients with ocular hypertension (OHT) and 24 healthy control subjects were included in a clinical study. Nerve fibre layer imaging was performed using a scanning laser ophthalmoscope (SLO, Rodenstock Instr. argon laser 488 nm). Nerve fibre layer defects were analysed peripapillarily for every single degree (defect or no defect) at 1.7 mm (near) and at 3.4 mm (far) distance to the optic nerve head. Specificity and sensitivity of the HRT II were calculated using the Moorfields regression analysis (MRA). RESULTS: Patients with glaucoma were found to have 109 ± 92° (near) and 109 ± 92° (far) defects of the nerve fibre layer. Patients with OHT (8 ± 14° [far] and 6 ± 11° [near]) and control subjects (0 ± 0° [far] and 0 ± 1° [near]) showed significantly smaller defects (p < 0.0001). Sensitivity at > 90 % specificity for POAG and controls was 85.7 % (far) and 82.9 % (near). Sensitivity at > 90 % specifity for OHT and POAG was 85.7 % (far) und 82.9 % (near). Specificity of controls for the MRA was 83.3 % (borderline classified as normal). Specificity of OHT patients was 93.8 % (borderline classified normal). Sensitivity of the MRA for POAG was 80.9 % (borderline classified normal) and 90.5 % (borderline classified glaucoma). CONCLUSIONS: Nerve fiber layer imaging using a manually operated scanning laser ophthalmoscope was found to achieve a higher diagnostic precision as compared to optic disc evaluation using the HRT II.