Association of retinal vessel caliber and visual field defects in glaucoma

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Abstract

PURPOSE: This study evaluates the asymmetry of peripapillary retinal vessel caliber between inferior and superior hemispheres in eyes with visual field defects predominantly in one hemifield.

DESIGN: Observational case series.

METHODS: In a retrospective study, 64 eyes of 64 patients with primary open-angle glaucoma who had a marked difference in visual field defects between hemifields and who had no history of diabetes, trauma, or vascular occlusive disease were studied. The diameters of the superior and inferotemporal vessels were measured at the optic disk border with calipers on an enlarged image.

RESULTS: In 64 eyes, the average ratio of the superior temporal artery diameter to inferotemporal artery diameter was significantly greater in the eyes with predominantly superior visual field defects as compared with those with inferior defects (1.10 ± 0.22 vs. 0.92 ± 0.19, respectively, P = .002, two-tailed t test). This indicates that the arteriole corresponding to the hemifield with the greater visual field defect was narrower than the arteriole in the other hemifield. This relationship was confirmed using χ2 analysis (P = .002) comparing the proportions of eyes with ratios greater or less than normal vessel caliber ratios (normal ratio = 0.95 from data reported by Jonas and associates to the location of the dominant field defect. No statistically significant relationship was detected between retinal vein diameter and localized visual field defects, as determined by both the unpaired t test and χ2 analysis.

CONCLUSION: In eyes with primary open-angle glaucoma, this study demonstrates a strong association between decreased peripapillary arteriole diameter and visual field defects in the corresponding hemifield. This reflects either an ischemic basis for glaucomatous damage or vascular constriction when there are fewer axons to nourish.

Section snippets

Methods

A search of more than 4000 charts netted 64 that satisfied the inclusion criteria for this study. Inclusion criteria consisted of a diagnosis of primary open-angle glaucoma, fundus photographs taken within one year of corresponding visual fields tests and the presence of asymmetric visual fields. Exclusion criteria included a history of diabetes, trauma, or vascular occlusive disease.

Asymmetric Goldmann visual fields were defined as having either an arcuate or nasal step scotoma of at least 20

Results

The average patient age was 65.8 years old with an age range of 31 to 87 years. The group included 26 males and 38 females. Twenty-three patients carried a diagnosis of systemic hypertension. Other common systemic diseases included thyroid abnormalities, asthma, and arthritis. Corrected visual acuity had a range from 6/5 to 6/18 with 45 eyes having visual acuity of 6/7.5 or better. The cup-to-disk ratio averaged 0.82 with a range of 0.6 to 0.95. All patients used topical therapy, alone or in

Discussion

This study demonstrates a strong association between retinal arteriole diameter and localized visual field defects in primary open angle glaucoma. We correlated visual field loss predominantly in one hemifield with peripapillary vessel narrowing in the corresponding hemisphere of the retina. We used strict criteria to select eyes with distinct hemifield visual field loss.

The ratio of the diameter of the superotemporal artery to the inferotemporal artery was used to define vessel narrowing,

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