Blue-on-yellow visual field and retinal nerve fiber layer in ocular hypertension and glaucoma

doi:10.1016/S0161-6420(98)91128-9

Ophthalmology

Volume 105, Issue 11, 1 November 1998, Pages 2077-2081

https://doi.org/10.1016/S0161-6420(98)91128-9 Get rights and content

Abstract

Background and objective

It has been suggested that the clinically detectable changes of the blue-on-yellow (B/Y) visual field and retinal nerve fiber layer (RNFL) may precede standard white-on-white (W/W) visual field defects in the progression of glaucoma. The aim of this study was to test the relationship between the results of B/Y visual fields and semiquantitative RNFL evaluation in corresponding areas and to determine how the B/Y visual fields and RNFL scores label the normal W/W perimetry hemifields in patients with glaucoma and ocular hypertension.

Design

A cohort study.

Participants and methods

Monochromatic RNFL photographs of 32 normal subjects and 29 patients with ocular hypertension and different stages of glaucoma were assessed in a masked fashion. The B/Y and W/W visual fields (program 30–2) were examined with a Humphrey perimeter. The results of both visual fields were adjusted for the patients’ age and lens transmission index measured with a lens fluorometer.

Main outcome measure

Mean deviation (MD) of visual field and semiquantitative score of RNFL loss were measured.

Results

The total and hemifield MD values of B/Y and W/W visual field showed a statistically significant correlation with diffuse and overall score of RNFL loss in corresponding areas. The hemifield MD values of B/Y perimetry obtained from “normal” W/W hemifields of patients with early glaucoma were well correlated (r = −0.56) with respective RNFL loss scores found to be abnormal in 84% of hemispheres. The difference between the hemifield MD values of B/Y perimetry obtained from normal W/W hemifields of patients with ocular hypertension and patients with early glaucoma was not statistically significant (analysis of variance). The respective B/Y hemifield data of normal subjects were statistically significantly different from the data of patients with ocular hypertension and early glaucoma.

Conclusions

The hemifield MD values of B/Y perimetry correlate well with semiquantitative scores of RNFL loss obtained from the corresponding hemisphere. The B/Y perimetry as well as RNFL assessment may show glaucomatous defects in a hemifield found to be normal on W/W perimetry. In subjects with ocular hypertension, the functional damage detected by B/Y perimetry may, in some cases, precede RNFL defects on conversion to glaucoma.

Section snippets

Nerve fiber layer evaluation

Retinal nerve fiber layer (RNFL) photographs were taken with a 60° wide-angle fundus camera (Canon, Inc, Kawasaki City, Japan) with a monochromatic blue interference filter on low-sensitivity black-and-white film. The technique of RNFL photography has been reported earlier in detail.7 The RNFL loss was assessed using the semiquantitative scoring method described previously5 by one of the authors (PJA) in a completely masked fashion with the optic discs covered. The photographs were analyzed in

Results

The MD values of B/Y and W/W visual field (program 24-2) were both statistically highly significantly related to the total diffuse nerve fiber layer loss score (Pearson’s r = −0.73 and −0.71, respectively; P < 0.0001) when all subjects (N = 61) were included in the analysis. The correlation of B/Y visual field MD values plotted against the total diffuse nerve fiber loss score is shown in Figure 2. A statistically significant correlation was also found between the B/Y and W/W visual field MD

Discussion

The correlation between the results of achromatic perimetry and RNFL evaluation has been reported by several previous studies.4, 6, 9, 12 It also has been shown that in the progression of glaucoma, the W/W visual field defects follow the pattern of earlier detected B/Y visual field defects.14, 15 Recently, Yamagishi et al22 reported that abnormality in optic disc showed by confocal scanning laser ophthalmoscopy and defects found on B/Y visual field testing are related topographically in

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Cited by (33)

Predictive value of short wavelength automated perimetry: A 3-year follow-up study
2002, Ophthalmology
Citation Excerpt :
Sommer et al17 reported, in a 10-year follow-up study, that RNFL defects preceded the onset of the visual field loss by 6 years. Meanwhile, it has been reported that SWAP can detect visual field loss at early stages of the disease,21–24 with a high correspondence with optic disc and RNFL defects.26–31 In this study, 11 of 58 eyes with initial SWAP loss had visual field defects develop in standard automated perimetry.
To determine whether structural changes in the retinal nerve fiber layer (RNFL) and functional abnormalities in short-wavelength automated perimetry (SWAP) can predict the onset of functional losses in standard automated perimetry patients suspected of having glaucoma.
Prospective observational case series.
A total of 160 eyes of ocular hypertensive subjects (intraocular pressure greater than 21 mmHg and normal standard automated perimetry) were included in the study.
The subjects underwent RNFL photographic evaluation and SWAP. Standard automated perimetries were repeated after 3 years to evaluate glaucomatous losses.
Onset of glaucomatous defects in conventional automated perimetry after 3 years of follow-up, with or without prior glaucomatous defects in RNFL and SWAP.
At the beginning of the study, 77 eyes showed RNFL losses (48%), and 58 eyes showed abnormalities in SWAP (36%). After the 3-year follow-up period, 14 of 77 eyes with RNFL losses had standard automated perimetry abnormalities (predicting sensitivity 93%), whereas 11 of 58 eyes with abnormal SWAP had standard automated perimetry losses (73% sensitivity).
RNFL and SWAP losses are signs of early glaucomatous damage and can predict functional losses in standard automated perimetry.
Optimum criteria for short-wavelength automated perimetry
2001, Ophthalmology
To determine the optimum perimetric criteria for short-wavelength automated perimetry on the basis of probabilistic maps that best discriminate between normal and glaucoma.
Comparative cross-sectional study.
Ninety-five glaucomatous eyes and 128 normal eyes were included in the study.
The subjects underwent retinal nerve fiber layer photographic evaluation and short-wavelength automated perimetry.
A probabilistic map of differential points for short-wavelength automated perimetry was elaborated, and the number of altered points was calculated for each visual field and level of significance (95%, 98%, 99%, and 99.5%).
The presence of a cluster of four or more points outside 95% normal probability limit showed a good combination of sensitivity and specificity. At deeper levels, P < 1% and P < 0.5%, the best combination is achieved with three points outside the normal probability limits.
The optimum criterion to define glaucomatous abnormalities in short-wavelength automated perimetry is the presence of a cluster of four points lower than P < 5% or a cluster of three points lower than P < 1%.
What does functional testing tell us about optic nerve damage?
2001, Survey of Ophthalmology
Information from different regions of the visual field travels through specific bundles of retinal ganglion cell axons. This visual information is disrupted in patients with glaucoma, and the effects can be seen in measurements of the visual field and optic nerve. Typical shapes and sizes of glaucomatous field defects result from damage to these nerve fiber bundles at the level of the optic disk, and we have identified specific patterns of progression. These patterns apply to the visual function-specific field tests that are designed to indirectly assess sub-populations of retinal ganglion cells. The rationale for these tests is described. An argument for the importance of using visual function techniques to assess progression in an individual patient is given.
Short-wavelength automated perimetry: It's role in the clinic and for understanding ganglion cell function
2000, Progress in Retinal and Eye Research
Short-wavelength automated perimetry (SWAP) is a more sensitive test than standard achromatic perimetry for early loss of vision due to glaucoma and other ocular and neurological diseases. SWAP is also more successful for detecting changes in vision as glaucoma progresses. Results from various visual function-specific tests, including SWAP, suggest that there are individual differences in ocular hypertensive and glaucoma eyes in the subtype of ganglion cell first affected. However, the disease targets the same retinal area for all function-specific tests that show a deficit in a given individual. Psychophysical tests of vision are critical to understand glaucoma’s effect on retinal ganglion cells, to verify the success or failure of treatment including new neuroprotective agents, and to determine the relationship of genetic markers for glaucoma to the presence and progress of the disease.
Short wavelength automated perimetry and standard automated perimetry in central serous chorioretinopathy
2020, Scientific Reports
The diagnostic use of choroidal thickness analysis and its correlation with visual field indices in glaucoma using spectral domain optical coherence tomography
2017, PLoS ONE

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^☆: Supported by a grant from the Silmä-ja Kudospankki Foundation and a scholarship of the Nordic Council of Ministers.

¹: The authors have no proprietary interest in any of the materials used in this study.

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Blue-on-yellow visual field and retinal nerve fiber layer in ocular hypertension and glaucoma1☆,

Abstract

Background and objective

Design

Participants and methods

Main outcome measure

Results

Conclusions

Section snippets

Nerve fiber layer evaluation

Results

Discussion

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Fundoscopy of nerve fiber layer defects in glaucoma

Invest Ophthalmol

The nerve fiber layer in the diagnosis of glaucoma

Arch Ophthalmol

Clinical evaluation of nerve fiber layer atrophy as an indicator of glaucomatous optic nerve damage

Arch Ophthalmol

Visual field and retinal nerve fibre layer in early glaucoma after optic disc haemorrhage

Acta Ophthalmol (Copenh)

Visual field and retinal nerve fiber layer comparisons in glaucoma

Arch Ophthalmol

Examination of the retinal nerve fiber layer in the recognition of early glaucoma damage

Trans Am Ophthalmol Soc

Blue-on-yellow visual field and retinal nerve fiber layer in ocular hypertension and glaucoma¹☆,