Korean J Ophthalmol.  2014 Aug;28(4):330-336.

Patterns of Subsequent Progression of Localized Retinal Nerve Fiber Layer Defects on Red-free Fundus Photographs in Normal-tension Glaucoma

• Kim TJ
• Kim YK
• Kim DM

Abstract

PURPOSE
To investigate patterns of subsequent progression of localized retinal nerve fiber layer (RNFL) defects and 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 localized RNFL defect on serial red-free fundus photographs were selected for the study. Patterns of subsequent progression of localized RNFL defects were categorized, and extents of progression were quantified. Serial evaluations 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 defect after appearance of a new defect (n = 2, 6.1%). Four eyes (12.1%) simultaneously showed two patterns of subsequent progression. In 13 eyes that showed continuous widening of the defect, subsequent angular widening towards the macula and away from the macula were 9.2 ± 6.0degrees (range, 1.1degrees to 24.4degrees; n = 11) and 5.2 ± 4.9degrees (range, 0.3degrees to 11.3degrees; n = 2), respectively. Thirty-two eyes showed no progression of optic disc cupping. Out of the 21 eyes in which Humphrey central 30-2 threshold visual field tests were performed after progression 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 defect proceeded temporally, especially in the defect located at the inferior fundus, might be at a risk of further RNFL loss temporally.

Keyword

Low tension glaucoma; Nerve fibers; Progression

MeSH Terms

Adult
Aged
Disease Progression
Female
Follow-Up Studies
Humans
Intraocular Pressure/physiology
Low Tension Glaucoma/*diagnosis/physiopathology
Male
Middle Aged
Nerve Fibers/*pathology
Optic Disk/pathology
Photography
Retinal Ganglion Cells/*pathology
Tonometry, Ocular
Visual Fields/physiology

Figure

• 

  Fig. 1 Red-free fundus photographs show patterns of continuous progression of localized retinal nerve fiber layer defects such as (A) continuous widening (arrow heads and empty arrow) of the defect towards the macula, (B) continuous widening (arrow heads and empty arrow) of the defect away from the macula, (C) continuous sharpening of the border (arrow heads and empty arrow) of the defect, (D) continuous appearance of a new defect (arrow heads and empty arrow), and (E) appearance of a new defect (arrow heads) followed by deepening of the defect (empty arrow). Arrows in the left first photographs indicate the location of the defect.

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