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목적 : Eyes with initial bi-hemifield defects show faster progression compared to eyes with initial single-hemifield involvement, suggesting greater optic nerve susceptibility to glaucomatous damage in these patients. We hypothesized that certain disc phenotypes may exist in glaucoma patients who have bi-hemispheric structural damage at the initial stage of disease.
We identified the optic disc characteristics related to bi-hemispheric retinal nerve fiber layer (RNFL) defects in early-stage primary open angle glaucoma (POAG).
방법 : 136 eyes with POAG were divided into two groups based on the presence of RNFL defects in both the superior and inferior hemispheres. Group 1 patients had single-hemispheric RNFL defects, and group 2 patients had bi-hemispheric RNFL defects. Disc tilt (ovality) was defined as the ratio between the longest and shortest diameter of the optic disc. The degree of horizontal tilt angle and asymmetry in RNFL thickness between hemispheres (defined as the difference between superior and inferior average RNFL thickness) were measured using Cirrus spectral domain-optical coherence tomography.
결과 : Group 2 patients had significantly higher disc ovality, proportion of tilted disc, and OCT-measured horizontal tilt angle compared to group 1 patients (P < 0.05). The asymmetry in RNFL thickness significantly decreased with increased disc ovality (P= 0.015), although it was not associated with spherical equivalent, axial length, or the angle between temporal retinal veins. In multivariate logistic analyses, disc ovality was found to be an independent risk factor for bi-hemispheric RNFL defects, after controlling for mean deviation, age, axial length, and disc area (P = 0.017).
결론 : Optic disc tilt was associated with bi-hemispheric RNFL defects in early glaucoma patients, regardless of their refractive status. These data suggest that disc tilt, associated with bi-hemispheric structural damages, is a risk factor for glaucoma progression.
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