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Year : 2019  |  Volume : 1  |  Issue : 1  |  Page : 2

Relationship between spectral domain optical coherence tomography and the perimetry automated in glaucoma suspect and glaucoma in hispanic population

Department of Ophthalmology, Military Central Hospital, Nueva Granada Military University, Bogotá, Colombia

Date of Submission08-Jul-2019
Date of Acceptance10-Jul-2019
Date of Web Publication08-Aug-2019

Correspondence Address:
Dr. Jeanneth Toquica
Cll152 # 12 C 12 Unit 315, Bogotá
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2219-4665.264045

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Purpose: The aim of the study is to evaluate the structure-function relationship measured with NIDEK RS-3000 advance spectral-domain optical coherence tomography and standard automated perimetry (SAP) in a Hispanic population.
Methods: Eighty-three eyes with open-angle glaucoma (mean age: 63.4 years, 24% male and 76% female) and 163 eyes with glaucoma suspects (mean age: 51.6 years, 38% male and 62% female) were included in a cross-sectional study. The connection between retinal nerve fiber layer (RNFL), optic disc and ganglion cell complex (GCC) reduction, and visual field losses were evaluated, and Pearson's correlation coefficients (R) was calculated.
Results: A significant but mild correlation (R = 0.24; P < 0.002) was seen between functional and structural parameters in glaucoma suspects. After the classification of the patients by the Hodapp–Parrish–Anderson glaucoma grading scale, at mild glaucoma, it was established a significant correlation between SAP with temporal RNFL (R = 0314; P < 0.003) and optic disc (R = 0.36; P < 0.012). In relation to moderate glaucoma, it was found a higher correlation between temporal thinning of RNFL (R = 0.734; P < 0.005) and inferior GCC (R = 0.506; P < 0.023). At advanced glaucoma, there was a stronger correlation (R = 0.711;xz P < 0.014) between superior RNFL and optic disc with corresponding topographic SAP locations.
Conclusions: There were significant correlations between RNFL, optic disc and GCC loss, and deficits on SAP that increase with the glaucoma severity. This damage could be predictive of visual field loss, the defects went from generalized to localized, and the change rates were directly related to the stage of the disease.

Keywords: Ganglion cell complex, optical coherence tomography, retinal nerve fiber layer, visual field

How to cite this article:
Toquica J, Gomez-Goyeneche F, Velandia-Plata M, Sarmiento-Forero D, Ardila-Duarte G. Relationship between spectral domain optical coherence tomography and the perimetry automated in glaucoma suspect and glaucoma in hispanic population. Pan Am J Ophthalmol 2019;1:2

How to cite this URL:
Toquica J, Gomez-Goyeneche F, Velandia-Plata M, Sarmiento-Forero D, Ardila-Duarte G. Relationship between spectral domain optical coherence tomography and the perimetry automated in glaucoma suspect and glaucoma in hispanic population. Pan Am J Ophthalmol [serial online] 2019 [cited 2023 May 28];1:2. Available from: https://www.thepajo.org/text.asp?2019/1/1/2/264045

  Introduction Top

Glaucoma is a progressive optic neuropathy of multifactorial etiology characterized by morphological changes in the optic nerve, loss of nerve fiber layer, and death of retinal ganglion cells that are associated with progressive loss of visual field.[1]

According to reports from the World Health Organization, it is estimated that there are 285 million people visually impaired, of these, 39 million are blind and 249 million have low vision.[2] Most striking is that 80% of the cases of low vision and blindness could be cured or prevented. Due to the great socioeconomic impact, this disease represents,[3] the goal, from the point of view of diagnosis, is to achieve early detection and better monitoring of the disease.

Optical coherence tomography (OCT) is a technique that has demonstrated its efficacy in the detection of structural glaucomatous damage,[4] even in the early stages of the disease, offering objective, quantitative, and reproducible data on the retinal nerve fiber layer (RNFL)[5] and the optic disc or optic nerve head.[6] Even a single broad-field OCT is sufficient for early diagnosis with excellent sensitivity and specificity.[7] On the other hand, functional damage can be detected earlier with perimetry techniques of high sensitivity and specificity.

Recent studies indicate that the first detectable glaucomatous change can be functional and structural,[8] some authors have suggested that a combination of functional and structural tests can increase the diagnostic sensitivity.[9]

Our work seeks to evaluate and compare, the connection, structure-function, between retinal sensitivity measured with standard automated perimetry (SAP) and the structural parameters of optic disc, RNFL, and ganglion cell complex (GCC) between glaucoma suspects and early glaucoma, using spectral-domain (SD) OCT technology ) (NIDEK RS-3000 advance) in a Hispanic population to identify the areas of early damage and higher risk of functional loss.

  Methods Top

A descriptive, retrospective, observational study designed and included 81 eyes of patients with open-angle glaucoma and 163 eyes of patients with suspected glaucoma treated at the Central Military Hospital and the Country Clinic Medical Unit between January 2010 and December 2015.

All clinical records of patients with open-angle glaucoma diagnoses and glaucoma suspects that met the following criteria: age ranged between 18 and 80 years, corrected visual acuity better or equal to 20/30, refraction sphere between +5.00 and −5.00 and cylinder between ±3, and anisometropia less than two-dimensional. Patients with coexisting retinal disease, sequelae of trauma or ocular inflammation, congenital anatomical ocular alterations, optic neuropathy of neurological origin, and intraocular surgery with the exception of uncomplicated cataract surgery were excluded from the study.

Open-angle glaucoma patients were considered in cases with typical perimetric glaucomatous defects (arcuate or paracentral scotoma and/or nasal step in at least two separate reliable tests with mean deviation (MD) ≥−6 db, 3 or more adjacent points with 5 db depression, or two points with depression of more than 10 db), associated with changes in the disc such as cup/disc radius >0.6, evidence of focal or diffuse thinning of the neural ridge, disc hemorrhages, RNFL defects, discs asymmetry >0.2, and open angles based in Shaffer gonioscopy.[10] The glaucoma suspects included were those cases with these same changes in the optic nerve and/or intraocular pressure ≥22 mmHg but with normal SAP.

Standard automated perimetry

All visual fields tests were obtained from the Humphrey Field Analyzer model 750i database strategy 24-2 SITA Standard stimulus III. The visual field test was considered reliable if it presented false-positive and/or false-negative losses of <15%.

The point-to-point sensitivity was recorded in an Excel template and then grouped by zones according to the Garway–Heath map[11] [Figure 1]. Once the glaucoma patients were collected, they were classified according to the Hodapp–Parrish–Anderson scale[12] modified as follows: mild glaucoma: MD ≥−6.00 db, moderate glaucoma: MD ≥−6.00 to −12.00 db, and advanced glaucoma: MD ≥−12.01 to −20.00 db.
Figure 1: Garway–Heath map

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Optical coherence tomography's-spectral domain measurements

RFNL, macula, and optic disc protocol images of the OCT were extracted from the Nidek RS-3000 advance tomography. For RNFL and optic disc, data were collected of the average total thickness, mean thickness RNFL in each quadrant (upper: 46°–135°, nasal: 136°–225°, lower: 226°–315°, and temporary: 316°–345°) coding by color according to the normative base of the software for each quadrant (upper, lower, temporal, and nasal), area of the optical disc, vertical cup/disc ratio, and horizontal cup/disc ratio. For GCC, mean thickness in each quadrant (upper and lower) and color coding according to the software's normative base.[13]


The results of the perimetry were converted to a linear scale (antilogarithmic) to be able to compare them with the RNFL, optic disc, and GCC measurements. Subsequently, the Pearson's correlation coefficients were calculated between the mean RNFL thickness, optic disc, and GCC in each quadrant obtained by the OCT and the mean sensitivity of each region of the visual field test for glaucoma suspects and mild glaucoma. For moderate and advanced glaucoma, the Spearman correlation coefficients were applied. All the variables of the visual field, MD, standard deviation, Hemifield test for glaucoma, and Visual Field Index with the RNFL, optical disc, and GCC thickness in each quadrant in all the samples, and the results of these thicknesses with each other were correlated.

  Results Top

The clinical records of 123 patients who had a diagnosis of primary open-angle glaucoma were reviewed: 79 eyes from 41 patients met the inclusion criteria, 24% men and 76% women [Table 1]; 64.56% (48/79) patients with mild glaucoma, 22.78% (20/79) moderate glaucoma, and 12.66% (11/79) advanced glaucoma. From the glaucoma [Table 2] suspects group, 434 clinical histories were reviewed; 163 eyes of 82 patients met the inclusion criteria.
Table 1: Demographic and clinical characteristics of subgroups of patients with glaucoma suspect and glaucoma

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Table 2: Subgroups clinical characteristics of patients with suspect glaucoma and glaucoma

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Retinal sensitivity by standard perimetry in three subgroups of glaucoma, a progressive sensitivity decrease was observed stronger in zones 5 and 6 and less loss in zone 4.

In glaucoma suspects, a significant correlation was found between MD and RNFL average of 18% (P < 0.05), while the sensitivity zone study showed a significant correlation of superior RNFL with zone 3 of 24% (P < 0.05) and lower RNFL and zone 6 of 16% (P < 0.05) and upper optical disc with zone 3 of 19%. The GCC showed no significant correlation with any area.

For mild glaucoma, a significant correlation was evidenced between the MD and the RNFL average of 29% (P < 0.05). The study of the correlation by quadrants showed a correlation of temporal RNFL and MD of 36% (P < 0.05), thickness of the temporal optic disk and MD of 37% (P < 0.05), and upper GCC of 38% and lower 29% with MD (P < 0.05). Regarding to retinal sensitivity, a significant correlation of 31% (P < 0.05) was found between temporal RNFL and visual field area. 5. In the optic disc, was found a significant correlation between thickness in temporal region with zone 1 of 36%, and with area 5 of 33% (p <0.05); in the GCC a significant correlation was found between zone 5 with areas upper in 42% and lower in 38%. Optic disk thickness correlation with the different zones is available in [Figure 2].
Figure 2: Average db sensitivity by zones and stage in patients with primary open-angle glaucoma

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For moderate glaucoma, a significant 46% correlation was found between nasal RNFL and pattern SD (PSD) (P < 0.05). By areas of retinal sensitivity, significant correlation was found between zone 5 and RNFL thickness in the temporal area of 73% (P < 0.05) and inferior GCC and zone 6 of 50% (P < 0.05). The analysis of the optic disc and areas of retinal sensitivity, no significant correlation was found.

  Discussion Top

There is a relation between structure and function associated to the decrease in the thickness of the RNFL, optic disc, and the GCC with a decrease in retinal sensitivity in the automated perimetry evidenced in glaucoma suspects similar to the one described by many authors,[7],[14],[15],[16],[17],[18],[19] and it gets worse as glaucoma progresses.

Glaucoma suspects have the highest correlation between thickness of upper and lower RNFL and upper optical disc with their respective sensitivity zones. These results agree with the results of the study by Leite et al.[20] who explains these findings, because the ranges of loss of retinal sensitivity are very narrow in this population.

In mild glaucoma, the temporal areas of the optic disc and RNFL showed a significant structural and functional damage correlation, a result like that found by Gardiner et al.,[15] who considered the area's commitment as predictive of visual field loss. However, it was the GCC, in its lower areas, followed by superior for both mild and moderate glaucoma that led the most significant correlation of the study (0.7). In advanced glaucoma, the upper sectors of RNFL and optic disc showed a correlation of 0.71.

Another significant observation was the correlation between MD and RNFL in glaucoma suspects and mild glaucoma in the temporal quadrant of the optic disc, the correlation was also significant in the upper and lower GCC. In moderate glaucoma the correlation was significant between PSD and RNFL. For advance glaucoma the most significant correlation was between PSD and GCC, which suggests that the visual field defects go from generalized to localized.

Finally, the areas of GCC, optical disc, and RNFL that showed the greatest thinning in the OCT were the lowest, in agreement with the greater loss of sensitivity with their corresponding zones (5 and 6 of Gardway–Heath) in the standard perimetry from very early stages. Findings also found by Rao et al.,[21] Monsalve et al.,[22] and Hood.[7]

Our study had an important limitation; due to its transversal design, the number of patients with advanced glaucoma was small in comparison to the mild and moderate. In addition, this type of study does not allow the establishment of causality in the relationship between structure loss and function. In addition, we do not have baseline values to evaluate progression over time.

  Conclusions Top

There is a connection between the decreased thickness of the RNFL, the optic disc, and the GCC, and this damage could be predictive of visual field loss, the defects go from generalized to localized, and the change rates are directly related to the stage of the disease. This study allows us to understand the course of glaucomatous disease and could be used in our clinical practice, also, could help to improve interpretation of the clinical tests used daily.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: A review. JAMA 2014;311:1901-11.  Back to cited text no. 1
North R. Global causes of blindness and visual impairment. Optician 2011;241:31-8.  Back to cited text no. 2
Lee PP, Levin LA, Walt JG, Chiang T, Katz LM, Dolgitser M, et al. Cost of patients with primary open-angle glaucoma: A retrospective study of commercial insurance claims data. Ophthalmology 2007;114:1241-7.  Back to cited text no. 3
Brandao LM, Ledolter AA, Schötzau A, Palmowski-Wolfe AM. Comparison of Two Different OCT Systems: Retina Layer Segmentation and Impact on Structure-Function Analysis in Glaucoma. J Ophthalmol 2016;2016:8307639. doi: 10.1155/2016/8307639.  Back to cited text no. 4
Lee KM, Lee EJ, Kim TW, Kim H. Comparison of the abilities of SD-OCT and SS-OCT in evaluating the thickness of the macular inner retinal layer for glaucoma diagnosis. PLoS One 2016;11:e0147964.  Back to cited text no. 5
Ganesh Babu TR, Shenbaga Devi S, Venkatesh R. Optic nerve head segmentation using fundus images and optical coherence tomography images for glaucoma detection. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015;159:607-15.  Back to cited text no. 6
Hood DC. Improving our understanding, and detection, of glaucomatous damage: An approach based upon optical coherence tomography (OCT). Prog Retin Eye Res 2017;57:46-75.  Back to cited text no. 7
Hood DC, Kardon RH. A framework for comparing structural and functional measures of glaucomatous damage. Prog Retin Eye Res 2007;26:688-710.  Back to cited text no. 8
Raza AS, Zhang X, De Moraes CG, Reisman CA, Liebmann JM, Ritch R, et al. Improving glaucoma detection using spatially correspondent clusters of damage and by combining standard automated perimetry and optical coherence tomography. Invest Ophthalmol Vis Sci 2014;55:612-24.  Back to cited text no. 9
Prum BE Jr., Rosenberg LF, Gedde SJ, Mansberger SL, Stein JD, Moroi SE, et al. Primary open-angle glaucoma preferred practice pattern(®) guidelines. Ophthalmology 2016;123:P41-111.  Back to cited text no. 10
Garway-Heath DF, Poinoosawmy D, Fitzke FW, Hitchings RA. Mapping the visual field to the optic disc in normal tension glaucoma eyes. Ophthalmology 2000;107:1809-15.  Back to cited text no. 11
Hodapp E, Parrish RK II, Anderson DR. Clinical Decisions In Glaucoma: Medicine & Health Science Books St Louis: The CV Mosby Co; 1993. p. 52-61.  Back to cited text no. 12
Savini G, Carbonelli M, Barboni P. Spectral-domain optical coherence tomography for the diagnosis and follow-up of glaucoma. Curr Opin Ophthalmol 2011;22:115-23.  Back to cited text no. 13
Garway-Heath DF, Holder GE, Fitzke FW, Hitchings RA. Relationship between electrophysiological, psychophysical, and anatomical measurements in glaucoma. Invest Ophthalmol Vis Sci 2002;43:2213-20.  Back to cited text no. 14
Gardiner SK, Johnson CA, Cioffi GA. Evaluation of the structure-function relationship in glaucoma. Invest Ophthalmol Vis Sci 2005;46:3712-7.  Back to cited text no. 15
Harwerth RS, Wheat JL, Fredette MJ, Anderson DR. Linking structure and function in glaucoma. Prog Retin Eye Res 2010;29:249-71.  Back to cited text no. 16
Kanamori A, Naka M, Nagai-Kusuhara A, Yamada Y, Nakamura M, Negi A. Regional relationship between retinal nerve fiber layer thickness and corresponding visual field sensitivity in glaucomatous eyes. Arch Ophthalmol 2008;126:1500-6.  Back to cited text no. 17
Ferreras A, Pablo LE, Garway-Heath DF, Fogagnolo P, García-Feijoo J. Mapping standard automated perimetry to the peripapillary retinal nerve fiber layer in glaucoma. Invest Ophthalmol Vis Sci 2008;49:3018-25.  Back to cited text no. 18
Hood DC, Anderson SC, Wall M, Raza AS, Kardon RH. A test of a linear model of glaucomatous structure-function loss reveals sources of variability in retinal nerve fiber and visual field measurements. Invest Ophthalmol Vis Sci 2009;50:4254-66.  Back to cited text no. 19
Leite MT, Zangwill LM, Weinreb RN, Rao HL, Alencar LM, Medeiros FA. Structure-function relationships using the cirrus spectral domain optical coherence tomograph and standard automated perimetry. J Glaucoma 2012;21:49-54.  Back to cited text no. 20
Rao HL, Zangwill LM, Weinreb RN, Leite MT, Sample PA, Medeiros FA. Structure-function relationship in glaucoma using spectral-domain optical coherence tomography. Arch Ophthalmol 2011;129:864-71.  Back to cited text no. 21
Monsalve B, Ferreras A, Khawaja AP, Calvo P, Ara M, Fogagnolo P, et al. The relationship between structure and function as measured by OCT and octopus perimetry. Br J Ophthalmol 2015;99:1230-5.  Back to cited text no. 22


  [Figure 1], [Figure 2]

  [Table 1], [Table 2]


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