Korean J Ophthalmol.  2014 Aug;28(4):323-329.

Depth and Area of Retinal Nerve Fiber Layer Damage and Visual Field Correlation Analysis

• Suh W
• Lee JM
• Kee C

Abstract

PURPOSE
To evaluate the relationship between the structural damage as assessed by time-domain optical coherence tomography (OCT) and functional changes in glaucoma.
METHODS
In total, 190 patients with normal tension glaucoma or primary open angle glaucoma were included in this study. The thickness of retinal nerve fiber layer (RNFL) around the optic disc and the area of RNFL defect were determined using OCT scans. The relationships between the RNFL thickness or area of the defect and visual field (VF) indices were assessed using the Lowess function, regression analysis and partial Spearman correlation. The differences between these associations depending on the stage of VF damage were further analyzed. Age, optic disc size, refraction, central corneal thickness and the presence of systemic disease were corrected for in order to exclude confounding factors.
RESULTS
A logarithmic scale of RNFL thickness showed a negative linear relationship with VF indices. The area of the RNFL defect showed a weak correlation with the pattern of standard deviation, whereas the remnant RNFL thickness was moderately correlated with the pattern of standard deviation (partial Spearman correlation coefficient, 0.39, -0.47, respectively; p < 0.0001). Many outliers were detected in the Lowess-plotted graphs. Multiplication of the area and the inverted RNFL thickness showed a moderately correlated logarithmic relationship with the VF indices (partial Spearman correlation coefficient, 0.46; 95% confidence interval, 0.34 to 0.57; p < 0.0001). In the severe stage of VF damage, correlation between the area of the RNFL defect and mean deviation was significantly greater than in other stages (partial Spearman correlation coefficient, -0.66; p = 0.02).
CONCLUSIONS
The thickness of the RNFL had a negative logarithmic correlation with the VF indices and was more relevant to the VF indices than the area of the RNFL defect, as measured by OCT.

Keyword

Glaucoma; Retinal nerve fiber layer; Visual fields

MeSH Terms

Aged
Female
Glaucoma, Open-Angle/*physiopathology
Humans
Low Tension Glaucoma/*physiopathology
Male
Middle Aged
Nerve Fibers/*pathology
Optic Nerve Diseases/*physiopathology
Retinal Ganglion Cells/*pathology
Tomography, Optical Coherence
Visual Field Tests
Visual Fields/*physiology

Figure

• 

  Fig. 1 Correlation between retinal nerve fiber layer (RNFL) thickness and visual field (VF) index. In the correlation analysis with mean deviation (MD), the slope of RNFL thickness changed rapidly around the numerical value of 81 (A). A logarithmic scale of the RNFL thickness showed a negative linear relationship with the MD index of the VF (B). When the residual of the RNFL thickness was plotted, the normality was not satisfied and many outliers were present (C,D). The slope of the pattern of standard deviation (PSD) line changed rapidly at the point when the RNFL thickness was 84.25 (E). The Lowess plot of the RNFL thickness and PSD suggested a logarithmic relationship (F).

• 

  Fig. 2 Correlation between retinal nerve fiber layer (RNFL) defect range and visual field index. The area of the RNFL defect showed a negative linear relationship with the mean deviation (MD) (A). However, in the relationship with pattern of standard deviation (PSD), the area of the RNFL defect showed a logarithmic scale correlation, as shown by a Lowess plot (B,C).

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