Mapping the visual field to the optic disc in normal tension glaucoma eyes

doi:10.1016/S0161-6420(00)00284-0

Ophthalmology

Volume 107, Issue 10, October 2000, Pages 1809-1815

Presented in part at the Glaucoma Society (UK & Eire) Annual Meeting, London, England, November 1998.

https://doi.org/10.1016/S0161-6420(00)00284-0 Get rights and content

Abstract

Purpose

To establish the anatomical relationship between visual field test points in the Humphrey 24-2 test pattern and regions of the optic nerve head (ONH)

Design

Cross-sectional study.

Participants

Glaucoma patients and suspects from the Normal Tension Glaucoma Clinic at Moorfields Eye Hospital.

Methods

Sixty-nine retinal nerve fiber layer (RNFL) photographs with well-defined RNFL defects and/or prominent bundles were digitized. An appropriately scaled Humphrey 24-2 visual field grid and an ONH reference circle, divided into 30° sectors, were generated digitally. These were superimposed onto the RNFL images. The relationship of visual field test points to the circumference of the ONH was estimated by noting the proximity of test points to RNFL defects and/or prominent bundles. The position of the ONH in relation to the fovea was also noted.

Main outcome measures

The sector at the ONH corresponding to each visual field test point, the position of the ONH in relation to the fovea, and the effect of the latter on the former.

Results

A median 22 (range, 4–58), of a possible 69, ONH positions were assigned to each visual field test point. The standard deviation of estimations was 7.2°. The position of the ONH was 15.5° (standard deviation 0.9°) nasal and 1.9° (standard deviation 1.0°) above the fovea. The location of the ONH had a significant effect on the corresponding position at the ONH for 28 of 52 visual field test points.

Conclusions

A clinically useful map that relates visual field test points to regions of the ONH has been produced. The map will aid clinical evaluation of glaucoma patients and suspects, as well as form the basis for investigations of the relationship between retinal light sensitivity and ONH structure.

Section snippets

RNFL photography

The archive of RNFL photographs from the Normal Tension Glaucoma Clinic at Moorfields Eye Hospital was searched for examples of photographs with discrete (focal and wedge) RNFL defects and/or prominent nerve fiber bundles, the course of which could easily be traced. Sixty-nine photographs of 69 eyes (63 patients) satisfied these criteria. If photographs of both eyes of a single patient met the criteria, both eyes were included (six patients).

Nerve fiber layer photography had been performed as

Results

Fifty-two field test points were assigned values, representing all points in the 24-2 test grid, except those immediately above and below the ONH.

A median of 22, of a possible 69, values was assigned to each point (range, 4–58). The mean value for each point is shown in Figure 4. In general, central points and points in the arcuate bundles were assigned more values than peripheral points. The median standard deviation of assigned values was 7.2° (range, 2.6°–10.3°). No locations in particular

Discussion

The map relating visual field test points to positions at the ONH (Fig 4) is, to our knowledge, the first complete map to be derived from human RNFL images. It is compared with Wirtschafter et al’s map in Figure 6. The maps differ in two significant respects. The first is that paracentral and arcuate areas of the visual field are represented by sectors nearer the poles of the ONH in the map derived from this study and by sectors nearer the temporal horizontal meridian in Wirtschafter’s map. The

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^☆: D. F. Garway-Heath is funded by the BUPA Fellowship (Royal College of Ophthalmologists/BUPA) and the David Cole Travel Award (Glaucoma Society (UK & Eire)/Merck Sharp & Dohme).

¹: The authors have no proprietary interest in the development or marketing of any product or instrument mentioned in this article.

View full text

Mapping the visual field to the optic disc in normal tension glaucoma eyes1☆,

Abstract

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

RNFL photography

Results

Discussion

Vision Res

Ophthalmology

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

A comparative study. Ophthalmology

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Fundus perimetry and Octopus perimetry for the evaluation of nerve fiber layer defects

High spatial resolution automated perimetry in glaucoma

Br J Ophthalmol

Biometric study of the disc cup in open-angle glaucoma

Graefes Arch Clin Exp Ophthalmol

Optic disc, cup and neuroretinal rim size, configuration and correlations in normal eyes [published errata appear in Invest Ophthalmol Vis Sci 1991;32:1893 and 1992;32:474–5]

Invest Ophthalmol Vis Sci

Quantitative evaluation of the optic nerve head in early glaucoma

Br J Ophthalmol

Ability of the Heidelberg retina tomograph to detect early glaucomatous visual field loss

J Glaucoma

Relationship of optic disc topography to optic nerve fiber number in glaucoma

Arch Ophthalmol

Mapping the visual field to the optic disc in normal tension glaucoma eyes¹☆,