Documenta Ophthalmologica 82: 279-286, 1992. 9 1992 Kluwer Academic Publishers. Printed in the Netherlands.
Disc and field damage in patients with unilateral visual field loss from primary open-angle glaucoma T H I E R R Y G. Z E Y E N , M A R K R A Y M O N D & J O S E P H C A P R I O L I The Glaucoma Section, Yale University School of Medicine, Department of Ophthalmology and Visual Science, New Haven, Conn., USA
Accepted 28 October 1992 Key words: Asymmetry, Glaucoma, Optic disc rim area, Planimetry, Perimetry, Visual field Abstract. To assess the temporal relationship between field and disc change in early glaucoma,
24 patients with unilateral visual field loss from primary open angle glaucoma were identified for planimetric optic disc measurements. Cross-sectional analysis of disc rim area was performed and compared to 25 age-matched normal controls. The mean (-+SD) disc rim area in eyes with normal visual fields (1.10-+ 0.31 mm2) was slightly larger than that of eyes with visual field loss (0.90-+ 0.33 mm2). The mean disc rim area in the control group (1.49-+ 0.19 mm2) was significantly different from both sets of eyes in the asymmetric primary open angle glaucoma patients (p = 0.000). These findings support the hypothesis that loss of the optic disc rim can be detected before perimetric abnormalities develop in patients with glaucoma.
Introduction
The available data suggest that perimetric abnormalities may be preceded by structural change of the optic nerve head [ l - 5 ] and have shifted attention to early and careful optic disc evaluation. Planimetric m e a s u r e m e n t s of disc stereophotographs have been described as a simple and reliable m e t h o d to quantify glaucomatous optic disc deterioration [6, 7]. In asymmetric primary open-angle glaucoma the unaffected eye is at high risk for future development of visual field defects [8-11]. We used planimetry to study quantitatively the optic nerves of patients with unilateral visual field loss from primary open-angle glaucoma in order to gather additional information about structural characteristics of the optic nerve in early glaucoma.
Material and methods Patient selection. Asymmetrical glaucoma was defined as primary open-
angle glaucoma with a normal visual field in one eye and a typical glaucomatous field defect in the contralateral eye. We screened the records of patients who had Octopus computerized visual fields tested with Pro-
280 grams P32 and G1 (Model 201; Interzeag, Schlieren-Switzerland) to identify patients who met the following criteria: 1) a clinical diagnosis of primary open-angle glaucoma and no evidence of pseudoexfoliation, pigment dispersion or any other ocular disease. 2) a reproducible glaucomatous field defect in one eye defined as: a) at least 10 dB loss in two or more contiguous points in the Bjerrums's area, compared with perimeter-defined age-matched normals; or b) at least 5 dB loss in three or more contiguous points in the Bjerrums's area; or c) 10 dB difference across the nasal horizontal midline in two or more adjacent points. 3) a normal visual field in the contralateral eye. 4) previolis experience with automated perimetry and false-positive and false-negative rates
Disc and field damage in patients with unilateral visual field loss from primary open-angle glaucoma T H I E R R Y G. Z E Y E N , M A R K R A Y M O N D & J O S E P H C A P R I O L I The Glaucoma Section, Yale University School of Medicine, Department of Ophthalmology and Visual Science, New Haven, Conn., USA
Accepted 28 October 1992 Key words: Asymmetry, Glaucoma, Optic disc rim area, Planimetry, Perimetry, Visual field Abstract. To assess the temporal relationship between field and disc change in early glaucoma,
24 patients with unilateral visual field loss from primary open angle glaucoma were identified for planimetric optic disc measurements. Cross-sectional analysis of disc rim area was performed and compared to 25 age-matched normal controls. The mean (-+SD) disc rim area in eyes with normal visual fields (1.10-+ 0.31 mm2) was slightly larger than that of eyes with visual field loss (0.90-+ 0.33 mm2). The mean disc rim area in the control group (1.49-+ 0.19 mm2) was significantly different from both sets of eyes in the asymmetric primary open angle glaucoma patients (p = 0.000). These findings support the hypothesis that loss of the optic disc rim can be detected before perimetric abnormalities develop in patients with glaucoma.
Introduction
The available data suggest that perimetric abnormalities may be preceded by structural change of the optic nerve head [ l - 5 ] and have shifted attention to early and careful optic disc evaluation. Planimetric m e a s u r e m e n t s of disc stereophotographs have been described as a simple and reliable m e t h o d to quantify glaucomatous optic disc deterioration [6, 7]. In asymmetric primary open-angle glaucoma the unaffected eye is at high risk for future development of visual field defects [8-11]. We used planimetry to study quantitatively the optic nerves of patients with unilateral visual field loss from primary open-angle glaucoma in order to gather additional information about structural characteristics of the optic nerve in early glaucoma.
Material and methods Patient selection. Asymmetrical glaucoma was defined as primary open-
angle glaucoma with a normal visual field in one eye and a typical glaucomatous field defect in the contralateral eye. We screened the records of patients who had Octopus computerized visual fields tested with Pro-
280 grams P32 and G1 (Model 201; Interzeag, Schlieren-Switzerland) to identify patients who met the following criteria: 1) a clinical diagnosis of primary open-angle glaucoma and no evidence of pseudoexfoliation, pigment dispersion or any other ocular disease. 2) a reproducible glaucomatous field defect in one eye defined as: a) at least 10 dB loss in two or more contiguous points in the Bjerrums's area, compared with perimeter-defined age-matched normals; or b) at least 5 dB loss in three or more contiguous points in the Bjerrums's area; or c) 10 dB difference across the nasal horizontal midline in two or more adjacent points. 3) a normal visual field in the contralateral eye. 4) previolis experience with automated perimetry and false-positive and false-negative rates
