Citicoline oral solution in glaucoma: is there a role in slowing disease progression?

PURPOSE: To assess the effect of citicoline on visual field rates of progression in patients with progressing glaucoma. PATIENTS AND METHODS: Forty-one patients with a diagnosis of progressing glaucoma received citicoline in oral solution for 2 years. Included were patients with a disease progression of at least -1 dB/year (at MD, mean deviation) for at least 3 years before entering the study despite controlled intraocular pressure (IOP). Patients were followed with 4 visual field examinations per year for 2 years. RESULTS: At baseline, the mean rate of progression was -1.1 (±0.7) dB/year despite the fact that the IOP had been below 18 mm Hg for at least 3 years. At study inclusion, the mean IOP was 15.5 (±2.6) mm Hg and the mean MD was -9.2 (±6.7) dB in the worst eye. Starting from the first cycle of treatment with citicoline, the mean rate of progression significantly changed to -0.15 (±0.3) dB/year at the end of the study (p = 0.01). CONCLUSIONS: This study seems to indicate that supplementation with citicoline might significantly slow down glaucomatous rates of progression.

An update on ripasudil for the treatment of glaucoma and ocular hypertension.

Ripasudil (K-115) is a novel Rho-associated protein kinase (ROCK) inhibitor. The Rho-ROCK pathway regulates key downstream effectors involved in many cellular functions, in particular in the actin cytoskeleton activity. The clinical effects of ripasudil expected on the eye include an intraocular pressure-lowering effect and a wound-healing activity on corneal endothelial cells, but many other functions are currently under investigation. To date, ripasudil has been approved in Japan (2014) for the treatment of glaucoma and ocular hypertension, and several clinical trials are currently investigating its role in the treatment of Fuchs' corneal dystrophy. In this review, we will discuss its pharmacokinetics, pharmacodynamics and clinical efficacy, focusing also on its safety and tolerability profile.

Rarebit perimetry and frequency doubling technology in patients with ocular hypertension.

PURPOSE: To test the capability of rarebit perimetry (RP), a recent non-conventional perimetric technique, in detecting early functional damage in subjects with ocular hypertension (OHT) and to compare RP findings with those obtained by frequency-doubling technology (FDT) perimetry. METHODS: Thirty patients with OHT were matched with 30 healthy subjects. All were tested with RP and FDT. Frequency-doubling technology mean deviation (MD) and pattern standard deviation (PSD), as well as RP mean hit rate (MHR), of the two groups were analyzed. The agreement between the two techniques was tested by Kappa analysis. RESULTS: In the OHT group the mean (SD) FDT MD was 0.5 (2.1), the mean (SD) FDT PSD was 4.2 (1.6), and the mean (SD) RP MHR was 81.4 (6.7). In the control group, corresponding values were mean (SD) FDT MD 1.1 (1.4), mean (SD) FDT PSD 3.0 (0.3), mean (SD) RP MHR 96.2 (2.0). The differences between the two groups were not significant for the studied indexes. Eleven (36.6%) out of the 30 OHT eyes had abnormal RP results; 12 (40.0%) eyes had abnormal FDT results. Five (16.6%) eyes had abnormal RP and FDT findings. Only 1 eye (3.3%) in the control group had abnormal RP results and 3 eyes (10.0%) had abnormal FDT results. RP and FDT showed a moderate agreement (Kappa=0.43; 95% CI: 0.42 to 0.51). CONCLUSIONS: RP and FDT showed VF defects not shown in standard automated perimetry in the OHT group. This may be indicative of an increased risk in developing glaucoma, even if a gold standard for detecting subtle defects is not currently available. RP has the additional advantage of not requiring any expensive device to be used. The poor agreement between these techniques in identifying eyes with early damage warrants further investigations. Large longitudinal studies are needed before defining the role of RP in early glaucoma diagnosis.

Visual field damage and progression in glaucomatous myopic eyes.

PURPOSE: To make a visual field retrospective analysis on a group of patients with primary open angle glaucoma (POAG) and to evaluate whether different refractive errors could have different progression of the 30 degrees central sensitivity. METHODS: A total of 110 patients with POAG (52 men and 58 women) were included in the study. All the patients were divided into four subgroups based on the refractive error. The visual field of all the included patients was assessed by an Octopus 30 degrees central visual field every 6 months, for a total of 837 visual fields examined. The resulting data were analyzed by PERIDATA for Windows 1.7 TREND function. Mean defect (MD) and loss variance (LV) were considered for the analysis. RESULTS: At the first examination, 82% of eyes showed a global decrease of differential light sensitivity (MD >2 dB) and in 67% the distribution of the defect was nonhomogeneous (LV >6 dB). The analysis of variance for subgroups showed a more significant decrease of MD in highly myopic patients. A linear regression analysis highlighted a statistically significant change in time of MD in 36% and of LV in 34% of the eyes studied. Highly myopic patients had the highest (p<0.01) percentage of change of MD and LV (46% and 42%, respectively). Among the four subgroups, there was no difference in progression of MD decrease in time. CONCLUSIONS: These results showed that after 5 years of glaucoma, the visual field was altered in most of the eyes examined (82%) and that in 67% of cases, its defect was nonhomogeneous and worsened with the increase of myopia. The regression linear analysis of visual field changes in time showed a progressive increase of MD and LV in approximately one third of all the eyes examined.

Sector-based analysis of frequency doubling technology sensitivity and optic nerve head shape parameters.

PURPOSE: To evaluate which Heidelberg Retina Tomograph (HRT) parameter is the best predictor of frequency doubling technology (FDT) sensitivity by using a sector based analysis between FDT and optic nerve head shape parameters such as cup shape measure (CSM) and rim area (RA), which have been shown to have the best correlation with FDT indices among all the HRT parameters. METHODS: One eye was randomly chosen from 100 patients with primary open angle glaucoma (abnormal visual field and/or abnormal optic nerve and untreated intraocular pressure above 21 mm Hg). All the patients were examined with Humphrey field analyzer (HFA), program 24-2, SITA standard, FDT program C 20, and HRT. RA and CSM for the HRT analysis and mean deviation, pattern standard deviation, and the sensitivity of each tested point for the FDT test were considered in this study. All the parameters were calculated as both global and sector measurements. Findings were analyzed using Pearson's correlation coefficient and linear regression model. RESULTS: Significant (p<0.001) correlation was found between FDT indices and HRT RA and CSM. Significant (p<0.001) sector correlation was found between FDT sensitivity and RA and CSM, but when a linear regression model was applied, RA was the most predictive parameter of FDT. Temporal CSM was more strongly correlated to FDT fovea sensitivity than temporal RA. Furthermore, sector HRT parameters were better correlated to HFA than to FDT. CONCLUSIONS: In this glaucomatous group, cup shape measure and RA were significantly correlated to FDT indices. RA was more predictive of FDT abnormality than CSM in all the considered sectors except in the temporal one. However, HFA was a stronger predictor of HRT parameters than FDT.

Retinal nerve fiber layer measured by Heidelberg retina tomograph and nerve fiber analyzer.

PURPOSE: To compare retinal nerve fiber layer (RNFL) thickness measured by Heidelberg retina tomograph (HRT) and nerve fiber analyzer (GDx). METHODS: Twenty eyes of 20 consecutive healthy subjects were recruited for this study. Each subject had a normal visual field and a normal optic nerve head, which was assessed by slit-lamp biomicroscopy using a 90 degrees lens. Using the HRT and GDx, RNFL measurement was calculated as for software vs 2.01 and vs 1.0.14, respectively. Retinal nerve fiber layer thickness was evaluated for the entire annulus surface every 5 degrees degrees. RNFL was assessed by HRT and GDx. HRT RNFL measurement was calculated at 0 microm from the edge, while GDx RNFL measurement at 1.75 disc diameter as for software. The difference between the highest points and the deepest points was calculated and compared. Furthermore, because of the possibility of different scales in the two systems, the following ratio was calculated: superior/inferior, superior/temporal, superior/nasal, inferior/temporal, and inferior/nasal. RESULTS: When the entire RNFL thickness was considered, a significant (p<0.001) difference was found between the HRT and GDx measurements. A difference of 200 microm was found between the highest and the deepest HRT points while a difference of 40 microm was found between the highest and the deepest GDx points. CONCLUSIONS: HRT and GDx RNFL measurements were statistically different in each sector. However, ratio parameters showed no difference between the obtained values except for superior/temporal ratio and inferior/temporal ratio.

Evaluation of Agreement between HRT III and iVue OCT in Glaucoma and Ocular Hypertension Patients.

Purpose. To determine the agreement between Moorfields Regression Analysis (MRA), Glaucoma Probability Score (GPS) of Heidelberg retinal tomograph (HRT III), and peripapillary nerve fibers thickness by iVue Optical Coherence Tomography (OCT). Methods. 72 eyes with ocular hypertension or primary open angle glaucoma (POAG) were included in the study: 54 eyes had normal visual fields (VF) and 18 had VF damage. All subjects performed achromatic 30° VF by Octopus Program G1X dynamic strategy and were imaged with HRT III and iVue OCT. Sectorial and global MRA, GPS, and OCT parameters were used for the analysis. Kappa statistic was used to assess the agreement between methods. Results. A significant agreement between iVue OCT and GPS for the inferotemporal quadrant (κ: 0.555) was found in patients with abnormal VF. A good overall agreement between GPS and MRA was found in all the eyes tested (κ: 0.511). A good agreement between iVue OCT and MRA was shown in the superonasal (κ: 0.656) and nasal (κ: 0.627) quadrants followed by the superotemporal (κ: 0.602) and inferotemporal (κ: 0.586) sectors in all the studied eyes. Conclusion. The highest percentages of agreement were found per quadrant of the MRA and the iVue OCT confirming that in glaucoma damage starts from the temporal hemiretina.

Optic nerve head morphologic characteristics in high-tension and normal-tension glaucoma.

OBJECTIVES: To determine the morphometric parameters in high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) with a confocal scanning laser ophthalmoscope, and to determine the relationship to disc size. METHODS: One hundred eighty-six patients with glaucoma were recruited for this study. For each patient, only one eye was randomly chosen. Patients with NTG and HTG were classified using untreated intraocular pressure (IOP) as the variable; the NTG group had IOP less than 22 mm Hg during a diurnal tension curve, while patients with HTG had IOP greater than 21 mm Hg in at least 3 measurements. All the patients were examined with Humphrey perimeter program 30-2 and a Heidelberg Retina Tomograph. Findings were assessed by t test. Patients were then divided by disc area size into 3 subgroups: small discs with an area less than 2 mm2, midsized discs with an area of 2 to 3 mm2, and large discs with an area greater than 3 mm2. RESULTS: One hundred thirty-two HTG eyes and 50 NTG eyes were assessed. Four eyes were excluded because they were classified as having secondary glaucoma. No significant differences were found between HTG and NTG eyes for any Heidelberg Retina Tomograph morphometric parameters, even when patients were divided into subgroups. CONCLUSION: No differences were apparent between HTG and NTG in morphometric parameters as measured by scanning laser ophthalmoscopy.

Topographic analysis to discriminate glaucomatous from normal optic nerve heads with a confocal scanning laser: new optic disk analysis without any observer input.

PURPOSE: We evaluated the potential ability of a confocal scanning laser ophthalmoscope to differentiate patients with normal visual fields from those with abnormal visual fields with an optic nerve head topographic map. PATIENTS AND METHODS: Twenty normal eyes with normal visual fields, intraocular pressures of less than 22 mm Hg, and no family history of glaucoma and 20 glaucomatous eyes with abnormal visual fields and open angles were selected. Glaucomatous eyes with advanced visual field damage were not included. One eye was chosen randomly from each patient. All eyes were examined with the Heidelberg Retina Tomograph (HRT [Heidelberg Engineering GMBH, Heidelberg, Germany]) and Humphrey Perimeter, program 30-2 (Humphrey Instruments, Inc., San Leandro, CA, USA). Topographic maps were analyzed with different methods based on contour lines, with use of a program able to differentiate glaucomatous from normal optic disks. Sensitivity, specificity, and diagnostic precision were calculated. RESULTS: The analysis had a sensitivity, specificity, and diagnostic precision of 80%, 100%, and 90%, respectively. CONCLUSION: With the topographic map data and this technique, the HRT's capacity to differentiate normal optic disks from glaucomatous disks was improved. In addition, with this method, we avoided any subjective observer input in drawing the optic nerve head outline.

Learning effect, short-term fluctuation, and long-term fluctuation in frequency doubling technique.

PURPOSE: To evaluate short-term and long-term fluctuations and learning effects in healthy subjects tested with the frequency doubling technique, which is based on a low spatial frequency and a high temporal frequency stimulus. METHODS: Twenty-three healthy adult subjects were consecutively recruited from volunteers, and 20 subjects finished the study. All the visual fields were assessed by the frequency doubling technique, program C-20, full threshold. The frequency doubling technique presents stimuli on a black-and-white video monitor with specialized control circuitry interfaced to a microprocessor. During program C-20, full threshold, 17 points are tested, one round point centrally and 16 square ones in the periphery up to 20 degrees of eccentricity. Each stimulus consists of a 0.25-cycle/degree sinusoidal grating undergoing a 25-Hz counterphase flicker. One eye of each patient was chosen at random. Each subject was tested once in the first session, three times in the second session, and once in the third and fourth sessions. Both short-term and long-term fluctuation were studied either as the average fluctuation value of all the points tested or as a point-to-point fluctuation. To study the learning effect, the results of the first session were compared with those of the second, the third, and the fourth sessions. RESULTS: The average mean sensitivity of the three examinations of the second session was 30.4 +/- 1.24 dB, and the average short-term fluctuation of all the subjects was 2.16 +/- 0.5 dB. The short-term fluctuation of each point tested ranged from 1.4 to 3.4 dB. The average mean sensitivity for all the sessions was 32.4 +/- 1.14 dB, with an average long-term fluctuation of 3.23 +/- 0.5 dB, and the long-term fluctuation of each tested point ranged from 2.5 to 4.4 dB. A mild learning effect was found between the first section and the others. CONCLUSION: Short-term and long-term fluctuations were similar to those known to occur with the conventional threshold perimetry when they were compared with the literature data. A learning effect was also observed and should be taken into account for the clinical use of this test.

Interobserver variability of optic disk variables measured by confocal scanning laser tomography.

PURPOSE: To assess the interobserver variation of confocal laser scanning tomographic measurements of the optic nerve head and to address the question of whether the addition of clinical optic disk photographs is helpful in outlining the optic disk margin and in reducing the observer-related variation of the measurements. PATIENTS AND METHODS: Optic disk variables for 16 eyes of 16 patients with glaucoma, generated by confocal laser scanning laser tomography (Heidelberg Retina Tomograph), were independently evaluated by four experienced glaucoma specialists, and the interobserver variability was calculated. A second separate review by the same observers included the use of clinical stereoscopic color optic nerve head photographs to aid definition of the optic disk margin. RESULTS: Optic disk parameters with the smallest interobserver variation were cup shape measure, maximum cup depth, height variation contour, and mean height contour. The intraobserver variation of these parameters did not increase when clinical optic disk slides were additionally available. Parameters with the highest interobserver variation were volume below surface, volume below reference, volume above surface, and volume above reference. The observer variation of these optic disk parameters increased significantly for two of the four examiners when clinical optic disk slides were additionally available for outlining the optic disk margin. CONCLUSION: Confocal laser scanning tomography of the optic nerve head can be improved significantly if clinical optic disk photographs are additionally available to help in outlining the optic disk margin. Because interobserver variation in the tomographic optic disk measurements can be significant, even if experienced observer are involved, tomographic optic disk measurements may be centralized in reading centers in the case of multicenter studies.

Survival analysis for success of Molteno tube implants.

AIM: To apply survival analysis in assessing the long term outcome of Molteno tube implantation and to identify risk factors for failure. METHODS: A retrospective, 10 year, consecutive case series study of 119 eyes that underwent implantation of a Molteno tube. The main outcome measures considered were intraocular pressure (IOP), visual acuity, and complications. RESULTS: A 30% or greater reduction in IOP was achieved in 68.9% of cases. However, the overall, "complete success" rate (IOP <22 mm Hg with no medications) after a mean (SD) follow up period of 43 (33) months (range 6-120) was only 33.6% despite a fall in mean (SD) IOP from 38.2 (8.2) mm Hg to 20.1 (11.0) mm Hg. The "qualified success" rate (IOP <22 mm Hg with or without medications) was 60.5%. Failure was most common in the first postoperative year but could occur after several years, the survival curve having an exponential shape. The only statistically significant risk factor for failure identified was pseudophakia, although eyes with neovascular glaucoma tended to fare poorly. Postoperative IOP tended to be lower after double plate than after single plate implantation. There was no significant difference in outcome based on age, sex, race, previous penetrating keratoplasty, or previous conjunctival surgery. CONCLUSIONS: In eyes at high risk of trabeculectomy failure, implantation of an aqueous shunt device should be considered. Pseudophakia should be considered an additional risk factor for failure. Early failure appeared relatively more common but long term follow up of all cases is recommended to ensure adequate management of late failures.

Discriminant analysis models for early detection of glaucomatous optic disc changes.

AIM: To evaluate and compare four different mathematical formulas for the early detection of morphometric optic nerve head changes in chronic open angle glaucoma. METHODS: The optic nerve heads of 161 patients with perimetrically defined glaucomatous optic nerve damage and of 194 normal subjects were examined by confocal laser scanning tomography. Using four formulas of linear discriminant analysis and the optic cup shape measure as the single optic disc variable, the predictive power of each of these methods was examined to differentiate between the normal eyes and the glaucoma eyes. RESULTS: The highest predictive power had an optic disc sector based formula, in particular in eyes with medium and large optic discs. This optic disc sector based formula was the one with the best agreement with the other formulas examined. It achieved a better predictability than any single optic disc variable evaluated. CONCLUSIONS: Combining quantitative optic disc variables by discriminant analysis functions, the predictive power of semiautomatic quantitative optic nerve head evaluation can be improved by providing the ophthalmologist with a diagnostic score for the detection of glaucomatous optic nerve damage. Because of the pattern of glaucomatous neuroretinal rim loss, an optic disc sector based discriminant formula may have a higher diagnostic precision than other formulas in detecting early glaucomatous damage.

RA/DA cumulative curve analysis of local and diffuse neuroretinal rim area damage in glaucoma patients.

AIM: To evaluate the validity of cumulative rim/disc area (RA/DA) curve analysis as a clinical tool for the identification of glaucoma induced optic disc pathology. METHODS: 71 normal and 83 glaucomatous eyes were evaluated from a series of 154 subjects recruited for this study. For each eye, the cumulative distribution of RA/DA was calculated from 36 equally spaced rim sectors of each optic disc obtained by the automatic evaluation of simultaneous videographics (Image-net X Rev.3/51b). To increase the sensitivity of this analysis in early glaucoma and in normal eyes, these cumulative curves were subsequently divided into two equal segments and the slopes of their respective regression lines compared. RESULTS: The median RA/DA value obtained from the 36 sectors was significantly different in glaucomatous eyes compared with normals (p < 0.001). Nevertheless, the curves (5th-95th percentile of the cumulative curves distribution) of early glaucomatous eyes fell within the normal range. When the cumulative curve of these marginal cases was then divided into two equal segments, the comparison of the slopes of the regression lines showed a significant difference (p < 0.05) in 100% of early glaucomatous eyes. Furthermore, normal eyes were shown to be true negatives in 93% of the cases in which no significant difference between the two slopes was observed. CONCLUSION: Analysis of the RA/DA cumulative curve from 36 sectors of the optic disc was a valid method for the identification of glaucomatous disc pathology; however, a further calculation of the slopes of the two RA/DA regression lines was needed to identify early glaucomatous damage.

Low spatial-contrast sensitivity in dry eyes.

PURPOSE: Blurred vision in keratoconjunctivitis sicca eyes could be the result of the loss of the glossy surface of the tear film because of changes in composition or thickness irregularities. Spatial-contrast sensitivity in keratoconjunctivitis sicca and normal control eyes was tested before and after a tear substitute. METHODS: Three different groups of subjects were enrolled: one group of dry eyes with nonsignificant signs of epithelial disease (n = 12), the second group of dry eye positive with 1% Bengal rose staining of the cornea and of the conjunctiva (n = 18), and a third of normal eyes as control group (n = 15). In all the 45 eyes, spatial-contrast sensitivity was tested under the best correction by means of the Vistech Multivision Contrast Tester 8000 (Vistech Consultants, Dayton, OH, U.S.A.) before and 15 min after the instillation of a 0.4% Na-hyaluronate tear substitute without preservatives. RESULTS: A significant decrease of spatial-contrast sensitivity ranging from 35 to 70% was present in keratoconjunctivitis sicca eyes compared with a third group of age-matched normal eyes used as control. The spatial-contrast sensitivity was significantly lower also in the presence of preserved corneal surface. The addition of a tear substitute improved spatial contrast-sensitivity thresholds in all groups. CONCLUSION: Tear-film disease can affect the transfer function of modulation of the ocular surface.

Retinal nerve fiber layer and physiological central corneal thickness.

PURPOSE: To determine the relationship between central corneal thickness and the measurement of retinal nerve fiber layer thickness around the optic nerve head using a confocal scanning laser polarimeter such as the Nerve Fiber Analyzer (GDx). METHODS: Forty-four eyes were recruited for this study. Each patient had a normal visual field and a healthy optic nerve head, which was assessed by slit-lamp biomicroscopy with a 90-diopter lens and by a scanning laser ophthalmoscope (Heidelberg Retina Tomograph). Using the GDx, retinal nerve fiber layer thickness was calculated from 1.75 disc diameters together with some standard GDx parameters, including the number, symmetry, superior ratio, inferior ratio, maximum modulation, and ellipse modulation. Corneal thickness was measured with the DGH-1000 ultrasonic pachymeter. Descriptive analysis was used and Pearson's r coefficient of correlation was calculated. RESULTS: Corneal thickness was not significantly correlated to retinal nerve fiber layer thickness, but it was significantly (P < 0.05) correlated to the other GDx parameters. CONCLUSION: From these data. peripapillary retinal nerve fiber layer thickness is shown not to be significantly correlated to the corneal thickness, even if for the standard GDx parameters a significant correlation was found.

Normal retinal nerve fiber layer thickness in the peripapillary region measured by scanning laser polarimetry.

PURPOSE: To measure retinal nerve fiber layer thickness (RNFLT) as a function of distance from the optic nerve head using a confocal scanning laser polarimeter, such as the Nerve Fiber Analyzer (GDx). METHODS: Twenty eyes of 20 healthy patients were recruited for this study. Each patient had a normal visual field and a healthy optic nerve head, which was assessed by slit-lamp biomicroscopy using a 90-diopter lens and by a scanning laser ophthalmoscope. Using the GDx, RNFLT was calculated from 1.1 disc diameters (DD) to 2.5 DD in 0.1-DD increments from the outer edge of the optic disc rim. RNFLT was successively evaluated for the entire annulus surface, for each quadrant, and for every 10 degree sector. RNFLT was calculated in retardation degrees. Differences in RNFLT were calculated by analysis of variance. RESULTS: When the entire RNFLT was considered, the measurements close to the optic nerve head (at 1.1 and 1.2 DD) were found to be significantly (0.05 < or = P < or = 0.01) different from those measured far from the disc (at 2.4 and 2.5 DD). The inferior quadrant had the greatest RNFLT followed by the superior quadrant. When RNFLT was analyzed for every 10 degrees, RNFLT at 1.1 and 1.2 DD was significantly (P < or = 0.001) different from that measured at 2.4 and 2.5 DD in almost all 36 sectors. In the 36 considered sectors, no significant difference was found for all the RNFLT values that were calculated in all the positions of the annulus surface between 1.1 and 1.7 DD. CONCLUSION: From these data, peripapillary RNFLT is shown to be significantly (P < or = 0.001) thinner in the periphery (2.5 DD) than around the optic disc (1.1 DD). However, the lack of any difference in RNFLT from 1.1 to 1.7 DD suggested that the mild variations to locate the optic disc contour line do not change the results of the analysis if the RNFLT is calculated within 1.8 DD.

Sector-based analysis of optic nerve head shape parameters and visual field indices in healthy and glaucomatous eyes.

PURPOSE: To evaluate the correlations between the sector optic nerve head parameters measured by Heidelberg Retina Tomograph (HRT, Heidelberg Engineering, Heidelberg, Germany), version 1.11S, and the visual field. METHODS: One eye was randomly chosen from 55 individuals with glaucoma and 50 healthy individuals. Each participant had at last one Humphrey visual field, program 30-2 (Humphrey Instruments, San Leandro, CA, U.S.A.), and three 10 degrees HRT pictures. From the mean of the three HRT pictures, global measurements, superior (45 degrees-135 degrees), nasal (135 degrees-225 degrees), inferior (225 degrees-315 degrees), and temporal (315 degrees-45 degrees) sector measurements were calculated for the following parameters: disc area, effective area, area below reference, mean height of contour, volume below surface, volume above surface, volume below reference, volume above reference, and third moment. From the visual field results, mean deviation (MD), superior MD, and inferior MD were calculated. For each HRT parameter we calculated the "r" Pearson correlation with the corresponding visual field measures. RESULTS: Within the combined healthy and glaucomatous groups we found highly significant (p < 0.001) correlations between the following HRT parameters and the visual field MD: inferior and mean high of contour (r = -0.53), inferior and third moment (r = -0.52), global and third moment (r = -0.49), inferior and volume above reference (r = 0.47), superior and third moment (r = -0.46), and superior and area below reference (r = -0.44). Correlations between global mean deviation and nasal or temporal sector parameters were generally smaller and less significant. CONCLUSIONS: Inferior and superior HRT sector parameters were correlated with the respective visual field indices. In many cases these correlations were as strong or stronger than with the global equivalent shape measures.

Retinal nerve fiber layer height in high-tension glaucoma and healthy eyes.

PURPOSE: To determine the correlations between the retinal nerve fiber layer height measured by Heidelberg Retina Tomograph, version 1.11, and visual field indices in healthy individuals and patients with glaucoma. METHODS: One eye was randomly chosen from 48 patients with glaucoma and 60 healthy individuals. All participants were classified using Humprey visual field, program 30-2 (Humphrey Instruments, Inc., San Leandro, CA, U.S.A.); mean deviation, pattern standard deviation, short-term fluctuation, and corrected pattern standard deviation were measured. Superior and inferior mean deviation were calculated. For each participants the mean Heidelberg Retina Tomograph was generated from three 10 degrees Heidelberg Retina Tomograph pictures. The Student t test was used to compare healthy and glaucomatous retinal nerve fiber layer (RNFL) mean degree values every 5 degrees. A global measurement, superior sector (25 degrees-125 degrees), nasal sector (130 degrees-230 degrees), inferior sector (235 degrees-335 degrees), temporal sector (340 degrees-20 degrees), and polar sector (superior + inferior) were calculated. The global, superior, nasal, inferior, temporal, and polar RNFL height (RNFLH) were compared between healthy individuals and patients with glaucoma. The correlation between global, superior, inferior, and polar retinal nerve fiber layer height and visual field was calculated. RESULTS: A significant difference was found for RNFLH mean from 45 degrees to 330 degrees and for the distribution of the means (as reflected by the standard deviation) from 85 degrees to 100 degrees, 260 degrees to 295 degrees, and 335 degrees to 5 degrees. From these data we created three new sectors: new superior sector (from 85 degrees to 100 degrees), new inferior sector (from 260 degrees to 295 degrees), and new polar sector (combining the new superior and the new inferior sector). Comparing the healthy individuals to the patients with glaucoma, the mean RNFLH values for each sector were found to differ significantly (p < 0.001), with the exception of the temporal sector. Significant correlations (p < 0.001) between the global RNFLH and mean deviation (r = -0.36), pattern standard deviation (r = 0.49), and corrected pattern standard deviation (r = 0.48) were found in healthy participants and those with glaucoma. The strongest correlations (p < 0.001) were found between the pattern standard deviation and the corrected pattern standard deviation with the new polar sector (r = 0.60 and r = 0.59, respectively). CONCLUSIONS: We found that the strongest correlations with the visual field were with the new polar and new inferior sector.

Correlation between the visual field indices and Heidelberg retina tomograph parameters.

PURPOSE: We wished to determine whether a relationship exists between Heidelberg retina tomograph (HRT) parameters and the visual field indices. METHODS: One eye was randomly chosen from 59 normal patients [normal visual field and normal optic nerve head (ONH) and intraocular pressure (IOP) < 21 mm Hg], 64 ocular hypertensive patients (normal visual field and normal OHN and IOP > 22 mm Hg), 124 high-tension glaucoma patients (abnormal visual field and/or abnormal optic nerve and IOP > 22 mm Hg) and 47 low-tension glaucoma patients (abnormal visual field and or optic disc and IOP < 21 mm Hg). All the patients were examined with Humphrey Perimeter, program 30-2, and HRT. Findings were assessed by analysis of variance, Pearson's correlation coefficient, and multiple linear regression. RESULTS: Among all subjects, we noted a statistically significant correlation (Pearson's r, p < 0.001) between cup area, cup/disc area ratio, rim area, rim volume, cup shape measure, and retinal nerve fiber layer cross-section area with mean deviation and corrected pattern SD. Multiple linear regression analysis demonstrated that rim area was the most important predictor of mean deviation and corrected pattern SD. CONCLUSIONS: The presence of significant correlations between some HRT parameters, such as rim area and cup shape measure and visual field indices, suggests that these HRT parameters could be good indicators of the degree of glaucomatous ONH damage.