Utilisation of the structure of the retinal nerve fiber layer and test strategy in visual field examination
1University of Oulu, Faculty of Medicine, Institute of Clinical Medicine, Department of Ophthalmology
2University of Tübingen, Centre for Ophthalmology, Institute for Ophthalmic research
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|Academic dissertation to be presented with the assent of the Faculty of Medicine of the University of Oulu for public defence in Auditorium 10 of Oulu University Hospital, on 18 June 2010, at 12 noon
Docent Marko Määttä
Professor Eija Vesti
The aim of this study was to create a mathematical model of the retinal nerve fiber layer and of the entire hill of vision, and to compare different perimetric methods and test grids in the detection of visual field loss in glaucoma and optic neuritis.
A mathematical model of the retinal nerve fiber layer was developed, based on traced nerve fiber bundle trajectories extracted from 55 fundus photographs of 55 human subjects. The model resembled the typical retinal nerve fiber layer course within 20° eccentricity from the foveola. The standard deviation of the calculated corresponding angular location at the optic nerve head circumference ranged from less than 1° up to 18° (mean 8.8°).
A smooth mathematical model of the hill of vision was created, based on 81 ophthalmologically healthy subjects. The model fit R2 was 0.72.
Applying individually condensed test grids in 41 glaucomatous eyes of 41 patients enhanced remarkably the detection of progression. Seven out of 11 (64%) of the progressive scotomata detected by spatially condensed grids would have been missed by the conventional 6° × 6° grid.
In 20 eyes of 20 patients with advanced glaucoma, the comparability of visual field areas obtained with semi-automated kinetic perimetry and automated static perimetry was satisfactory and within the range of the test-retest reliability of automated static perimetry.
Using a standardized grid of 191 static targets within the central 30° visual field, the most common finding in 100 eyes of 99 patients with acute optic neuritis were central scotomas, accounting for 41% of all visual field defects in affected eyes.
In conclusion, a model of the retinal nerve fiber layer was developed, which provided a detailed location specific estimate of the magnitude of the variability on the courses of retinal nerve fiber bundle trajectories in the human retina. A smooth mathematical model of the hill of vision with a satisfactory model fit was described for the 80° visual field. Individually condensed grids enabled the detection of a glaucomatous visual field progression more frequently and also earlier than conventional grids. Semi-automated kinetic perimetry was found to be a valuable alternative to automated static perimetry in monitoring advanced glaucomatous visual field loss. Using a grid with a higher spatial resolution may enhance the detection of small central visual field loss in optic neuritis.
Acta Universitatis Ouluensis. D, Medica
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