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Category: Volume 07 Issue 08 August 2019
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Title: Correlation between optic disc changes and visual field changes in glaucoma suspects­: A clinical study

Authors: Dr Nivedita Choudhury, Dr Dinesh Kumar Bhagat, Dr Anirban Chakrabarti

 DOI: https://dx.doi.org/10.18535/jmscr/v7i8.91

Abstract

Background: This study was done to identify a group of POAG suspects from the patients attending the O.P.D and to monitor them periodically for a period of one year for detecting early signs of glaucomatous damage of ONH and glaucomatous VFDs.

Materials & Methods: The present study was carried out in Mala Gujri Memorial Medical College, Department of Ophthalmology, Kishanganj from July 15th, 2016 to June 14th, 2017. About 50 glaucoma suspects were selected for the study from the patients attending the O.P.D. The selection was made on the basis of findings of gonioscopy, applanation tonometry, direct ophthalmoscopy, slit lamp biomicroscopy, stereoscopic visualization of ONH by +90D lens, automated perimetry by Humphrey Field analyzer (central 30-2 test) and fundus photography.

Results: Of the 100 eyes of 50 cases, suspicious ONH changes were found in 45 eyes of 24 glaucoma suspects, suspicious VFDs in 25 eyes of 18 glaucoma suspects and IOP > 21 mm of Hg/suspicious diurnal variation test &/or suspicious provocative test in 30 eyes of 20 glaucoma suspects. Of the 45 eyes of 24 glaucoma suspects with ONH changes, bilateral ONH changes were seen in 21 cases; rest 3 cases had unilateral ONH changes. Pallor of NRR and diffuse thinning of NRR was found in 44.4%, splinter hemorrhage in l1.1 %, notching of NRR in 11.1% and vertically oval cup in 33.3%. Regarding correlation of asymmetry of C/D with VFDs in glaucoma suspects, of the 50 glaucoma suspects, asymmetry of C/D was found in19 persons, of which asymmetry of 0.1 -0.3 in 12 persons and >0.3 were found in 7 persons. Of the 19 glaucoma suspects with asymmetric C/D, VFDs were seen in 20 eyes of 14 persons (6 persons had bilateral VFDs, 8 persons had unilateral VFDs). VFD percentage of 83.3% was noted in C/D asymmetry between 0.1-0.3 and 142.9% when asymmetry was >0.3. So increasing asymmetry of C/D was related to increasing percentage of VFDs.

Conclusion: The nature of VFDs correlated with ONH changes in established POAG. Localized field defects were seen in early and moderate ONH changes and more generalized field defects were revealed in advanced ONH changes. The nature of VFDs revealed the typical arrangement of nerve fibers in the retina and the optic nerve and the typical pattern of glaucomatous nerve damage. Regarding correlation of C/D with IOP in established POAG, an increase of C/D with increase in IOP was observed.

Keywords: Primary open angle glaucoma, ocular hypertension, glaucoma suspect, optic disc changes, visual field changes.

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Corresponding Author

Dr Dinesh Kumar Bhagat

Assistant Professor, Department of Ophthalmology, Mata Gujri Memorial Medical College & Lions Seva Kendra Hospital, Kishanganj, Bihar- 855107, India