We followed up 32 eyes of 32 patients with early glaucoma (22 with capsular glaucoma and ten with simple glaucoma) who received laser trabeculoplasty as a primary therapy. These eyes were compared with a matched control group of 32 eyes treated with medication initially. The success rate (intraocular pressure below 22 mm Hg with laser alone or medication alone) at five years was 50% (16 of 32 eyes) in the laser-treated group and 22% (seven of 32 eyes) in the control group (P less than .02). The control group required more modifications of their therapy to control intraocular pressure. The neuroretinal rim area in the control eyes decreased 2.5 times as much as in the laser group (P = .017). Changes in the Friedmann visual fields did not differ significantly between the two groups.
BACKGROUND: Blue-on-yellow (B/Y) perimetry can reveal visual field defects earlier and larger in extent than white-on-white (W/W) perimetry. The Heidelberg Retina Tomograph (HRT) produces a three-dimensional image of the optic disc. The aim of this study was to compare the strength of the association of the B/Y and W/W visual hemifield mean deviation (HMD) variables with the optic nerve head (ONH) morphological variables of the respective area. METHODS: We evaluated one randomly chosen eye of 40 normal subjects and 37 patients with ocular hypertension and different stages of glaucoma. The B/Y and W/W visual fields (program 30-2) were obtained with a Humphrey perimeter. Results of both visual fields were adjusted for the patient's age and lens transmission index measured with a lens fluorometer. HMD was calculated as the difference between the measured and expected hemifield mean sensitivity values, predicted by the regression model fitted in our nonglaucomatous subject data. The HRT with the software version 1.11 was used to acquire and evaluate the topographic measurements of the optic disc. RESULTS: The B/Y and W/W visual field HMDs showed statistically significant correlation with ONH parameters such as cup shape measure (CSM), rim volume, rim area, mean retinal nerve fiber layer (RNFL) thickness and RNFL cross-sectional area. With forward stepwise logistic regression analysis using B/Y hemifield data 38% of the glaucoma patient's normal W/W hemifields were classified abnormal. With the CSM alone in the model 52% of the cases were classified abnormal. CONCLUSIONS: B/Y visual field hemifield mean deviation values correlate well with ONH parameters examined with the HRT.
PURPOSE: To test the capability of the optical coherence tomography (OCT) to demonstrate and quantitate retinal nerve fiber layer (RNFL) defects. METHODS: The authors examined 6 eyes of 6 chronic open angle glaucoma patients with the OCT. The patients had abnormal Humphrey 30-2 visual fields which corresponded to RNFL defects visible in monochromatic fundus images taken with a digital imaging system. The RNFL images were used for directing the OCT scans to areas where most information was believed to be obtainable. Several linear scans of different lengths across healthy and abnormal RNFL regions were made. RESULTS: When the OCT images were compared to RNFL photographs, the defective areas showed reduced backscattering with the OCT, being distinctly different from the adjacent normal RNFL. Except for one case the RNFL thickness values were smaller in the areas of abnormal appearance compared to areas of normal appearance. CONCLUSION: This preliminary study suggests that the OCT examination results of the RNFL are in good agreement with the RNFL appearance in monochromatic fundus images.
We examined the magnification-corrected optic disc size in 54 patients with exfoliative glaucoma, 61 patients with primary open angle glaucoma, and 50 patients with low-tension glaucoma. The mean optic disc area in low-tension glaucoma was statistically significantly larger than that in primary open angle and exfoliative glaucoma. The mean values of eyes with primary open angle and exfoliative glaucoma did not differ significantly from each other. Frequency distribution of the optic disc size showed, however, that all three diagnostic groups differed significantly from each other. Small discs were more frequent in eyes with exfoliative glaucoma, and large discs were more frequent in eyes with low-tension glaucoma. In primary open angle glaucoma, small and large optic discs were found equally frequently. It is possible that in some eyes large optic discs are vulnerable to even low intraocular pressures due to qualitative properties of the extracellular matrix.
Pseudoexfoliation (PEX) of the lens capsule is a well-known risk factor for open-angle glaucoma. Its prevalence is known to increase by age in the same way as prevalence of age-dependent cataract. In the present paper the prevalence of PEX varied from 8.5 to 13.2% increasing by age. Lens opacities were statistically significantly more common in PEX-positive than PEX-negative eyes. The importance of detecting exfoliation from the lens surface is discussed.
The neuroretinal rim areas of 123 eyes (from five normal subjects, 75 patients with ocular hypertension, and 43 patients with glaucoma) were measured to determine the rate and pattern of rim area change during 5 to 15 years (mean, 10 years) of follow-up. Fifty-seven percent of the patients with ocular hypertension and 79% of those with glaucoma showed a statistically significant slope of rim area decrease, a high rate of loss being associated with a high initial rim area. Ninety percent of the variation of rim area loss was accounted for by variables other than the ones measured herein, however (age, disc area, initial rim area, and intraocular pressure). The yearly loss of rim area was 0.23% of the initial area in normal subjects, 0.47% and 2.75% in the patients with stable and deteriorating ocular hypertension, respectively, and 3.47% in the patients with deteriorating glaucoma. The pattern of rim area change was linear in 49% of the patients with a statistically significant rim area decrease, episodic in 22%, and curvilinear in 29%.
In primary juvenile glaucoma, the connective tissue of the juxtacanalicular zone and sclera undergo constant reorganization because of incessant synthesis and degradation of extracellular matrix components with pronounced fluctuations of electron density of collagen fibrils. Destructive changes in the perivascular nerve trunks were detected at all stages of the glaucoma process, including the initial stages: numerous large foci of cytoplasmic organelle destruction with the formation of autophagosomes and residual bodies predominated in the cytoplasm of myelinated axons of nerve cells.
The endothelium of the ocular drainage system (Schlemm's canal, collector tubules, and aqueous veins) in primary juvenile glaucoma undergoes degenerative dystrophic changes with compensatory hypertrophy and proliferation at the initial stages of the glaucomatous process and atrophy and desquamation at advanced and terminal stages. Progressive decrease in the pinocytous function of endotheliocytes, reduction of the protein-synthesizing and mitochondrial compartments of the cytoplasm, and formation of autophagosomes reflect the process of endotheliocyte degeneration in general.