양측 이측 시신경 위축을 보이는 환자에서 망막신경섬유층 두께가 시력 및 시야에 미치는 영향
Influence of RNFL Thickness on Visual Acuity and Visual Field in Bilateral Temporal Optic Atrophy
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목적: 빛간섭단층촬영을 이용하여 측정한 망막신경섬유층 두께가 양측 이측 시신경 위축을 보이는 환자의 시력과 시야에 미치는 영향을 알아보고자 하였다. 대상과 방법: 점진적 시력 감소를 호소하며 양측 시신경의 이측 위축 소견을 보이는 환자들을 대상으로 빛간섭단층촬영을 이용하여 각 구역별 망막신경섬유층 두께를 측정하였으며, 망막신경섬유층 두께가 최대교정시력과 험프리 자동시야검사를 이용한 평균편차 및 패턴표준편차에 미치는 영향을 분석하였다. 결과: 양측 이측 시신경 위축을 보이는 13명 26안과 같은 연령 및 성별의 정상안 13명 26안이 포함되었다. 환자군 26안과 정상안 26안에서 빛간섭단층촬영을 이용하여 망막신경섬유층 두께를 측정하였으며, 환자군 26안에서 시야검사를 이용하여 유의한 평균편차 및 패턴표준편차를 계산하였다. 양측 이측 시신경 위축을 보이는 환자들의 평균연령은 66.0 ± 12.3세(37-80세)로 평균 교정시력은 30/50 (20/200-20/20)이었다. 단순회귀분석결과, 이측 망막신경섬유층 두께가 얇을수록 최대교정시력은 낮았다(p=0.015). 하이측 망막신경섬유층 두께가 얇을수록 평균편차는 낮았으며(p=0.005), 하이측 망막신경섬유층 두께가 얇을수록(p=0.003), 하비측 망막신경섬유층 두께가 얇을수록(p=0.04), 비측 망막신경섬유층 두께가 얇을수록(p=0.008) 패턴표준편차는 높았다. 결론: 양측 이측 시신경 위축을 보이는 환자에서 최대교정시력과 평균편차, 패턴표준편차는 망막신경섬유층 두께와 유의한 인과관계를 보였으며, 이러한 환자들의 시력과 시야장애를 예측함에 있어 빛간섭단층촬영이 유용하게 사용될 수 있다.
Abstract
Purpose: To investigate the influence of retinal nerve fiber layer (RNFL) thickness on visual acuity and visual field in patients with bilateral temporal optic atrophy. Methods: Patients with characteristic features of gradual visual loss and temporal atrophy of both optic nerves were enrolled in this study. Among the patients, RNFL thickness of each area was measured with optical coherence tomography, and its influence on the best corrected visual acuity, mean deviation and pattern standard deviation calculated from the refractive test and Humphrey visual field test was analyzed. Results: The present study included 13 patients with bilateral temporal optic atrophy (26 eyes) and 13 normal controls (26 eyes). Optical coherence tomography was performed to calculate RNFL thickness in the 52 eyes. Among 26 eyes of patients with bilateral temporal optic atrophy, the Humphrey visual field test was performed to calculate the mean deviation and pattern standard deviation. The mean age in the patient group was 66.0 ± 12.3 years (37‒80 years), and 8 (30.8%) patients were male and 18 (69.2%) female. The mean best corrected visual acuity was 30/50 (20/200‒20/20). Simple regression analysis showed that a thinner temporal RNFL thickness was correlated with a lower the best corrected visual acuity (p = 0.015). The mean deviation was low when inferotemporal RNFL was thin (p = 0.005). Pattern standard deviation was high when inferotemporal (p = 0.003), inferonasal (p = 0.04) and nasal (p = 0.008) RNFLs were thin. Conclusions: Inferotemporal RNFL thickness was significantly correlated with best corrected visual acuity, mean deviation and pattern standard deviation of automated visual field test in patients with bilateral temporal optic neuropathy. Optical coherence tomography can be further used to estimate visual acuity and visual field defects in patients with optic atrophy.
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