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Jia S, Mei X, Chen L, Chan LH, Tsang C, Suen V, Li T, Zaw MW, Liu A, Thompson B, Sabel B, Woo G, Leung CKS, Yip SP, Chang DHF, Cheong AMY. Glaucoma Rehabilitation using ElectricAI Transcranial Stimulation (GREAT)-study protocol for randomized controlled trial using combined perceptual learning and transcranial electrical stimulation for vision enhancement. Trials 2024; 25:501. [PMID: 39039582 PMCID: PMC11264395 DOI: 10.1186/s13063-024-08314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/03/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Glaucoma patients with irreversible visual field loss often experience decreased quality of life, impaired mobility, and mental health challenges. Perceptual learning (PL) and transcranial electrical stimulation (tES) have emerged as promising interventions for vision rehabilitation, showing potential in restoring residual visual functions. The Glaucoma Rehabilitation using ElectricAI Transcranial stimulation (GREAT) project aims to investigate whether combining PL and tES is more effective than using either method alone in maximizing the visual function of glaucoma patients. Additionally, the study will assess the impact of these interventions on brain neural activity, blood biomarkers, mobility, mental health, quality of life, and fear of falling. METHODS The study employs a three-arm, double-blind, randomized, superiority-controlled design. Participants are randomly allocated in a 1:1:1 ratio to one of three groups receiving: (1) real PL and real tES, (2) real PL and sham tES, and (3) placebo PL and sham tES. Each participant undergoes 10 sessions per block (~ 1 h each), with a total of three blocks. Assessments are conducted at six time points: baseline, interim 1, interim 2, post-intervention, 1-month post-intervention, and 2-month post-intervention. The primary outcome is the mean deviation of the 24-2 visual field measured by the Humphrey visual field analyzer. Secondary outcomes include detection rate in the suprathreshold visual field, balance and gait functions, and electrophysiological and biological responses. This study also investigates changes in neurotransmitter metabolism, biomarkers, self-perceived quality of life, and psychological status before and after the intervention. DISCUSSION The GREAT project is the first study to assess the effectiveness of PL and tES in the rehabilitation of glaucoma. Our findings will offer comprehensive assessments of the impact of these treatments on a wide range of brain and vision-related metrics including visual field, neural activity, biomarkers, mobility, mental health, fear of falling, and quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT05874258 . Registered on May 15, 2023.
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Affiliation(s)
- Shuwen Jia
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Xiaolin Mei
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Lilin Chen
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Lok Hin Chan
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Celia Tsang
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Venus Suen
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Tingni Li
- Centre for Eye and Vision Research Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Myo Win Zaw
- Centre for Eye and Vision Research Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Amanda Liu
- Centre for Eye and Vision Research Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Ben Thompson
- Centre for Eye and Vision Research Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Bernhard Sabel
- Institute of Medical Psychology, University of Magdeburg, Magdeburg, Germany
| | - George Woo
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Christopher K S Leung
- Department of Ophthalmology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shea-Ping Yip
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Dorita H F Chang
- Department of Psychology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Allen M Y Cheong
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China.
- Centre for Eye and Vision Research Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China.
- Research Centre for SHARP Vision, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China.
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Bernstein IA, Fisher AC, Singh K, Wang SY. The Association Between Frailty and Visual Field Loss in US Adults. Am J Ophthalmol 2024; 257:38-45. [PMID: 37714282 PMCID: PMC10841077 DOI: 10.1016/j.ajo.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/16/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE To describe the association between visual field loss and frailty in a nationally representative cohort of US adults. DESIGN Retrospective cross-sectional study. METHODS The cohort included adults 40 years or older with complete eye examination data from the 2005-2006 and 2007-2008 National Health and Nutrition Examination Surveys (NHANES). Visual field loss (VFL) was determined by frequency doubling technology and a 2-2-1 algorithm. A 36-item deficit accumulation-based frailty index was used to divide subjects into 4 categories of increasing frailty severity. RESULTS Of the 4897 participants, 4402 (93.2%) had no VFL, 301 (4.1%) had unilateral VFL, and 194 (2.73%) had bilateral VFL. Within the sample, 2 subjects197 (53.1%) were categorized as non-frail, 1659 (31.3%) as vulnerable, 732 (11.3%) as mildly frail, and 312 (4.3%) as most frail. In multivariable models adjusted for demographics, visual acuity, and history of cataract surgery, subjects with unilateral VFL had higher adjusted odds of being in a more frail category (adjusted odds ratio [aOR], 2.07; 95% CI, 1.42-3.02) than subjects without VFL. Subjects with bilateral VFL also had higher odds of a more frail category compared to subjects without VFL (aOR, 1.74; 95% CI, 1.20-2.52). CONCLUSIONS In the 2005-2008 NHANES adult population, VFL is associated with higher odds of frailty, independent of central visual acuity loss. Frail individuals may be more susceptible to diseases that can cause VFL, and/or VFL may predispose to frailty. Additional studies are needed to determine the directionality of this relationship and to assess potential interventions.
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Affiliation(s)
- Isaac A Bernstein
- From the Department of Ophthalmology, Byers Eye Institute, Stanford University, Stanford, California, USA
| | - Ann Caroline Fisher
- From the Department of Ophthalmology, Byers Eye Institute, Stanford University, Stanford, California, USA
| | - Kuldev Singh
- From the Department of Ophthalmology, Byers Eye Institute, Stanford University, Stanford, California, USA
| | - Sophia Y Wang
- From the Department of Ophthalmology, Byers Eye Institute, Stanford University, Stanford, California, USA.
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Herbert P, Hou K, Bradley C, Hager G, Boland MV, Ramulu P, Unberath M, Yohannan J. Forecasting Risk of Future Rapid Glaucoma Worsening Using Early Visual Field, OCT, and Clinical Data. Ophthalmol Glaucoma 2023; 6:466-473. [PMID: 36944385 PMCID: PMC10509314 DOI: 10.1016/j.ogla.2023.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/20/2023] [Accepted: 03/10/2023] [Indexed: 03/22/2023]
Abstract
PURPOSE To assess whether we can forecast future rapid visual field (VF) worsening using deep learning models (DLMs) trained on early VF, OCT, and clinical data. DESIGN A retrospective cohort study. SUBJECTS In total, 4536 eyes from 2962 patients. Overall, 263 (5.80%) eyes underwent rapid VF worsening (mean deviation slope less than -1 dB/year across all VFs). METHODS We included eyes that met the following criteria: (1) followed for glaucoma or suspect status; (2) had at least 5 longitudinal reliable VFs (VF1, VF2, VF3, VF4, and VF5); and (3) had 1 reliable baseline OCT scan (OCT1) and 1 set of baseline clinical measurements (clinical1) at the time of VF1. We designed a DLM to forecast future rapid VF worsening. The input consisted of spatially oriented total deviation values from VF1 (including or not including VF2 and VF3 in some models) and retinal nerve fiber layer thickness values from the baseline OCT. We passed this VF/OCT stack into a vision transformer feature extractor, the output of which was concatenated with baseline clinical data before putting it through a linear classifier to predict the eye's risk of rapid VF worsening across the 5 VFs. We compared the performance of models with differing inputs by computing area under the curve (AUC) in the test set. Specifically, we trained models with the following inputs: (1) model V: VF1; (2) VC: VF1+ Clinical1; (3) VO: VF1+ OCT1; (4) VOC: VF1+ Clinical1+ OCT1; (5) V2: VF1 + VF2; (6) V2OC: VF1 + VF2 + Clinical1 + OCT1; (7) V3: VF1 + VF2 + VF3; and (8) V3OC: VF1 + VF2 + VF3 + Clinical1 + OCT1. MAIN OUTCOME MEASURES The AUC of DLMs when forecasting rapidly worsening eyes. RESULTS Model V3OC best forecasted rapid worsening with an AUC (95% confidence interval [CI]) of 0.87 (0.77-0.97). Remaining models in descending order of performance and their respective AUC (95% CI) were as follows: (1) model V3 (0.84 [0.74-0.95]), (2) model V2OC (0.81 [0.70-0.92]), (3) model V2 (0.81 [0.70-0.82]), (4) model VOC (0.77 [0.65-0.88]), (5) model VO (0.75 [0.64-0.88]), (6) model VC (0.75 [0.63-0.87]), and (7) model V (0.74 [0.62-0.86]). CONCLUSIONS Deep learning models can forecast future rapid glaucoma worsening with modest to high performance when trained using data from early in the disease course. Including baseline data from multiple modalities and subsequent visits improves performance beyond using VF data alone. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Patrick Herbert
- Malone Center For Engineering in Healthcare, Johns Hopkins University, Baltimore, Maryland
| | - Kaihua Hou
- Malone Center For Engineering in Healthcare, Johns Hopkins University, Baltimore, Maryland
| | - Chris Bradley
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Greg Hager
- Malone Center For Engineering in Healthcare, Johns Hopkins University, Baltimore, Maryland
| | - Michael V Boland
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Pradeep Ramulu
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Mathias Unberath
- Malone Center For Engineering in Healthcare, Johns Hopkins University, Baltimore, Maryland
| | - Jithin Yohannan
- Malone Center For Engineering in Healthcare, Johns Hopkins University, Baltimore, Maryland; Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
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Shiga Y, Nishida T, Jeoung JW, Di Polo A, Fortune B. Optical Coherence Tomography and Optical Coherence Tomography Angiography: Essential Tools for Detecting Glaucoma and Disease Progression. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1217125. [PMID: 37982032 PMCID: PMC10655832 DOI: 10.3389/fopht.2023.1217125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/03/2023] [Indexed: 11/21/2023]
Abstract
Early diagnosis and detection of disease progression are critical to successful therapeutic intervention in glaucoma, the leading cause of irreversible blindness worldwide. Optical coherence tomography (OCT) is a non-invasive imaging technique that allows objective quantification in vivo of key glaucomatous structural changes in the retina and the optic nerve head (ONH). Advances in OCT technology have increased the scan speed and enhanced image quality, contributing to early glaucoma diagnosis and monitoring, as well as the visualization of critically important structures deep within the ONH, such as the lamina cribrosa. OCT angiography (OCTA) is a dye-free technique for noninvasively assessing ocular microvasculature, including capillaries within each plexus serving the macula, peripapillary retina and ONH regions, as well as the deeper vessels of the choroid. This layer-specific assessment of the microvasculature has provided evidence that retinal and choroidal vascular impairments can occur during early stages of glaucoma, suggesting that OCTA-derived measurements could be used as biomarkers for enhancing detection of glaucoma and its progression, as well as to reveal novel insights about pathophysiology. Moreover, these innovations have demonstrated that damage to the macula, a critical region for the vision-related quality of life, can be observed in the early stages of glaucomatous eyes, leading to a paradigm shift in glaucoma monitoring. Other advances in software and hardware, such as artificial intelligence-based algorithms, adaptive optics, and visible-light OCT, may further benefit clinical management of glaucoma in the future. This article reviews the utility of OCT and OCTA for glaucoma diagnosis and disease progression detection, emphasizes the importance of detecting macula damage in glaucoma, and highlights the future perspective of OCT and OCTA. We conclude that the OCT and OCTA are essential glaucoma detection and monitoring tools, leading to clinical and economic benefits for patients and society.
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Affiliation(s)
- Yukihiro Shiga
- Neuroscience Division, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec H2X 0A9, Canada
- Department of Neuroscience, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California 92093, USA
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Adriana Di Polo
- Neuroscience Division, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec H2X 0A9, Canada
- Department of Neuroscience, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, 1225 NE Second Avenue, Portland, Oregon 97232, USA
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Jiang J, Ye C, Zhang C, Lin Z, Tang Y, Ye W, Xu X, Zhang S, Lu F, Liang Y. The Patterns of Visual Field Defects in Primary Angle-Closure Glaucoma Compared to High-Tension Glaucoma and Normal-Tension Glaucoma. Ophthalmic Res 2023; 66:940-948. [PMID: 37062276 DOI: 10.1159/000530175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 03/06/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION The aim of this study was to compare the patterns of visual field (VF) defects in primary angle-closure glaucoma (PACG) to control groups of eyes with high-tension glaucoma (HTG) and normal-tension glaucoma (NTG). METHODS Forty-eight eyes with PACG were enrolled, and control eyes with HTG and NTG matched for age, sex, and mean deviation of VF defect were selected. VF tests were performed using the 24-2 program of the Humphrey field analyzer. VF defects were classified into six patterns with the Ocular Hypertension Treatment Study classification system and were categorized into three stages (early, moderate, and advanced). Each hemifield was divided into five regions according to the Glaucoma Hemifield Test (GHT). The mean total deviation (TD) of each GHT region was calculated. RESULTS Compared with HTG and NTG groups, the partial arcuate VF defects were more common in the PACG group. In the PACG group, the nasal GHT region in the inferior hemifield had the worst mean TD (-8.48 ± 8.62 dB), followed by the arcuate 1 (-7.81 ± 7.91 dB), arcuate 2 (-7.46 ± 7.43 dB), paracentral (-7.19 ± 7.98 dB), and central (-5.14 ± 6.24 dB) regions; the mean TD of the central region was significantly better than those for all other regions (all p < 0.05). A similar trend was observed in the superior hemifield in the PACG group but not the VF hemifields of the HTG and NTG groups. CONCLUSION Patterns of VF defect in PACG patients differ from those with HTG and NTG. This discrepancy might be due to the differences in the pathogenic mechanisms of glaucomatous optic neuropathy.
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Affiliation(s)
- Junhong Jiang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Cong Ye
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Cong Zhang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Zhong Lin
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Yihua Tang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Wenqing Ye
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Xiang Xu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Shaodan Zhang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
- Glaucoma Institute, Wenzhou Medical University, Wenzhou, China
| | - Fan Lu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Yuanbo Liang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
- Glaucoma Institute, Wenzhou Medical University, Wenzhou, China
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Csoba I, Kunkli R. Rendering algorithms for aberrated human vision simulation. Vis Comput Ind Biomed Art 2023; 6:5. [PMID: 36930412 PMCID: PMC10023823 DOI: 10.1186/s42492-023-00132-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
Vision-simulated imagery-the process of generating images that mimic the human visual system-is a valuable tool with a wide spectrum of possible applications, including visual acuity measurements, personalized planning of corrective lenses and surgeries, vision-correcting displays, vision-related hardware development, and extended reality discomfort reduction. A critical property of human vision is that it is imperfect because of the highly influential wavefront aberrations that vary from person to person. This study provides an overview of the existing computational image generation techniques that properly simulate human vision in the presence of wavefront aberrations. These algorithms typically apply ray tracing with a detailed description of the simulated eye or utilize the point-spread function of the eye to perform convolution on the input image. Based on the description of the vision simulation techniques, several of their characteristic features have been evaluated and some potential application areas and research directions have been outlined.
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Affiliation(s)
- István Csoba
- Faculty of Informatics, University of Debrecen, Debrecen 4028, Hungary. .,Doctoral School of Informatics, University of Debrecen, Debrecen 4028, Hungary.
| | - Roland Kunkli
- Faculty of Informatics, University of Debrecen, Debrecen 4028, Hungary
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Impact of glaucoma on the spatial frequency processing of scenes in central vision. Vis Neurosci 2023; 40:E001. [PMID: 36752177 PMCID: PMC9970733 DOI: 10.1017/s0952523822000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Glaucoma is an eye disease characterized by a progressive vision loss usually starting in peripheral vision. However, a deficit for scene categorization is observed even in the preserved central vision of patients with glaucoma. We assessed the processing and integration of spatial frequencies in the central vision of patients with glaucoma during scene categorization, considering the severity of the disease, in comparison to age-matched controls. In the first session, participants had to categorize scenes filtered in low-spatial frequencies (LSFs) and high-spatial frequencies (HSFs) as a natural or an artificial scene. Results showed that the processing of spatial frequencies was impaired only for patients with severe glaucoma, in particular for HFS scenes. In the light of proactive models of visual perception, we investigated how LSF could guide the processing of HSF in a second session. We presented hybrid scenes (combining LSF and HSF from two scenes belonging to the same or different semantic category). Participants had to categorize the scene filtered in HSF while ignoring the scene filtered in LSF. Surprisingly, results showed that the semantic influence of LSF on HSF was greater for patients with early glaucoma than controls, and then disappeared for the severe cases. This study shows that a progressive destruction of retinal ganglion cells affects the spatial frequency processing in central vision. This deficit may, however, be compensated by increased reliance on predictive mechanisms at early stages of the disease which would however decline in more severe cases.
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Comparison of the Structure-Function Relationship Between Advanced Primary Open Angle Glaucoma and Normal Tension Glaucoma. J Glaucoma 2022; 31:574-583. [PMID: 35583511 DOI: 10.1097/ijg.0000000000002053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/07/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim was to investigate and compare the characteristics of visual field (VF) defects in primary open angle glaucoma (POAG) and normal-tension glaucoma (NTG) with advanced glaucomatous damage and to determine whether the structure-function relationships found in advanced glaucoma differ based on their glaucoma classification. PATIENTS AND METHODS Ninety-seven eyes of 97 patients (59 eyes with POAG and 38 eyes with NTG) with advanced glaucoma were included in this cross-sectional study. Scores at each test point of the 30-2 VF total deviation map were recorded, and average values at each test point were point-wise compared between the groups. Peripapillary retinal nerve fiber layer (RNFL) and macular thickness (total, RNFL, ganglion cell layer, and inner plexiform layer thickness) were measured. The structure-function relationship based on the map of Garway-Heath was determined and compared between the 2 groups. RESULTS At advanced stage of glaucoma, POAG eyes demonstrated more diffusely distributed VF defects, whereas NTG eyes had more severe VF defects at the superior nasal quadrant, showing increased asymmetry. Overall, peripapillary RNFL, macular ganglion cell layer, and macular inner plexiform layer thickness showed good relationships with 30-2 VF parameters in both groups. However, in total macula and macular RNFL thickness, the structure-function relationships tended to show different characteristics depending on the glaucoma classification; NTG eyes showed overall better relationships. CONCLUSIONS In advanced glaucoma, differences in patterns of VF damage were found between POAG and NTG eyes. Conventional peripapillary RNFL and macular measurements showed generally good performance for estimating functional status, particularly in NTG eyes.
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