Patterns of Subsequent Progression of Localized Retinal Nerve Fiber Layer Defects on Red-free Fundus Photographs in Normal-tension Glaucoma
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Purpose: To investigate patterns of subsequent progression of localized retinal nerve fiber layer (RNFL) defectsand to quantify the extent of progression in normal-tension glaucoma (NTG) patients. Methods: Thirty-three eyes of 33 consecutive NTG patients who had shown continuous progression of localizedRNFL defect on serial red-free fundus photographs were selected for the study. Patterns of subsequentprogression of localized RNFL defects were categorized, and extents of progression were quantified. Serialevaluations of disc stereophotographs and visual fields were also performed to detect progression. Results: The most common pattern was continuous widening of the defect towards the macula (n = 11,33.3%) followed by sharpening of the defect border after widening of the defect towards the macula (n = 5,15.2%), continuous widening of the defect away from the macula (n = 2, 6.1%), and deepening of the defectafter appearance of a new defect (n = 2, 6.1%). Four eyes (12.1%) simultaneously showed two patterns ofsubsequent progression. In 13 eyes that showed continuous widening of the defect, subsequent angularwidening towards the macula and away from the macula were 9.2 ± 6.0° (range, 1.1° to 24.4°; n = 11) and5.2 ± 4.9° (range, 0.3° to 11.3°; n = 2), respectively. Thirty-two eyes showed no progression of optic disccupping. Out of the 21 eyes in which Humphrey central 30-2 threshold visual field tests were performed afterprogression of RNFL defects, 15 eyes showed no deterioration in the visual field. Conclusions: There were nine patterns of subsequent progression of localized RNFL defects. Among them,continuous RNFL loss proceeding temporally was the most common one. Initial progression of the defectproceeded temporally, especially in the defect located at the inferior fundus, might be at a risk of further RNFLloss temporally.
Abstract
Purpose: To investigate patterns of subsequent progression of localized retinal nerve fiber layer (RNFL) defectsand to quantify the extent of progression in normal-tension glaucoma (NTG) patients. Methods: Thirty-three eyes of 33 consecutive NTG patients who had shown continuous progression of localizedRNFL defect on serial red-free fundus photographs were selected for the study. Patterns of subsequentprogression of localized RNFL defects were categorized, and extents of progression were quantified. Serialevaluations of disc stereophotographs and visual fields were also performed to detect progression. Results: The most common pattern was continuous widening of the defect towards the macula (n = 11,33.3%) followed by sharpening of the defect border after widening of the defect towards the macula (n = 5,15.2%), continuous widening of the defect away from the macula (n = 2, 6.1%), and deepening of the defectafter appearance of a new defect (n = 2, 6.1%). Four eyes (12.1%) simultaneously showed two patterns ofsubsequent progression. In 13 eyes that showed continuous widening of the defect, subsequent angularwidening towards the macula and away from the macula were 9.2 ± 6.0° (range, 1.1° to 24.4°; n = 11) and5.2 ± 4.9° (range, 0.3° to 11.3°; n = 2), respectively. Thirty-two eyes showed no progression of optic disccupping. Out of the 21 eyes in which Humphrey central 30-2 threshold visual field tests were performed afterprogression of RNFL defects, 15 eyes showed no deterioration in the visual field. Conclusions: There were nine patterns of subsequent progression of localized RNFL defects. Among them,continuous RNFL loss proceeding temporally was the most common one. Initial progression of the defectproceeded temporally, especially in the defect located at the inferior fundus, might be at a risk of further RNFLloss temporally.
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