Original Paper Ophthalmic Res 2013;49:192–198 DOI: 10.1159/000345074
Received: June 13, 2012 Accepted after revision: October 10, 2012 Published online: January 10, 2013
Comparison of Functional and Morphological Diagnostics in Glaucoma Patients and Healthy Subjects M.K.J. Klamann a A. Grünert b A.-K.B. Maier a J. Gonnermann a A.M. Joussen a K.K. Huber b a Department of Ophthalmology, University Medicine Charité Berlin, Berlin, and b Department of Ophthalmology, Heinrich Heine University, Duesseldorf, Germany
Key Words Blue-on-yellow perimetry ⴢ Glaucoma ⴢ Heidelberg Retina Tomograph III ⴢ Imaging ⴢ Microperimetry ⴢ Optical coherence tomography ⴢ Retinal nerve fibre layer thickness ⴢ Visual field testing
Abstract Purpose: To evaluate the diagnostic value of microperimetry (MP), blue-on-yellow perimetry (B/YP), confocal scanning laser ophthalmoscopy (Heidelberg Retina Tomograph, HRT, III) and optical coherence tomography (OCT) in discriminating eyes with early glaucoma from healthy subjects. Material and Methods: Prospective examination of 22 eyes of subjects with early primary open-angle glaucoma and 24 eyes of healthy control subjects. After a complete ophthalmological examination, B/YP, MP, OCT and HRT III were determined. Morphological and functional parameters were analysed. Results: Mean sensitivity threshold values obtained with B/YP and MP did not show significant differences between glaucoma patients and the control group (p = 0.321 and p = 0.281). Retinal nerve fibre layer (RNFL) thickness was significantly decreased in patients with glaucoma with both HRT III and OCT (p = 0.018 and p ! 0.001). Conclusions: While B/YP and MP had no ability to discriminate between subjects with early glaucoma and healthy subjects, RNFL thickness
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measured with HRT III and OCT showed a significant difference. In early primary open-angle glaucoma, morphological changes like RNFL thickness seem to occur prior to functional defects in the visual field. Copyright © 2013 S. Karger AG, Basel
Introduction
Glaucoma is a progressive optic neuropathy in which there is loss of retinal ganglion cells and corresponding nerve fibre layer loss resulting in visual field defects. Because injury due to glaucoma is largely irreversible, early detection and prevention of glaucomatous damage is crucial. It has been demonstrated that structural damage to the optic nerve head and retinal nerve fibre layer (RNFL) can occur well before any detectable functional visual loss [1, 2]. Other authors have shown that the opposite may also be true: in some cases, functional loss can be detected before structural loss [3, 4–6]. RNFL and optic nerve head evaluations are essential in primary open-angle glaucoma diagnosis. Classic diagnostic techniques, such as funduscopy or optic nerve head and RNFL photography, constitute a qualitative analysis of these structures with high subjectivity and variability [7, 8]. Matthias K.J. Klamann, MD Department of Ophthalmology University Medicine Charité Berlin Augustenburger Platz 1, DE–13353 Berlin (Germany) E-Mail matthias.klamann @ charite.de