Abstract • Standardized perimetry and nerve fiber layer and color fundus photography were performed annually on 1344 eyes with elevated intraocular pressures. In 83 eyes, glaucomatous field defects developed that met rigid criteria on manual kinetic and suprathreshold static perimetry. Individual nerve fiber layer photographs were read by two masked observers. The more sensitive of the two identified nerve fiber layer defects in 88% of readable photographs at the time field loss first occurred; 60% (6/10) of eyes already had nerve fiber layer defects 6 years before field loss. In contrast, the nerve fiber layer was considered abnormal in only 11% (3/27) of normal eyes and 26% (84/327) of hypertensive eyes. The location of nerve fiber layer and field defects closely corresponded, but nerve fiber layer loss was generally more widespread. Examiner experience and severity of optic nerve damage influenced results. Mild focal defects were more readily recognized than more severe diffuse atrophy. Nerve fiber layer defects expanded with time, often by the development and coalescence of adjacent areas of damage. References 1. Sommer A. Intraocular pressure and glaucoma . Am J Ophthalmol . 1989;107:186-188. 2. Anderson DR. Glaucoma: the damage caused by pressure: XLVI Edward Jackson Memorial Lecture . Am J Ophthalmol . 1989;108:485-495. 3. Van Buskirk EM. Glaucoma lexicon . Am J Ophthalmol . 1989;108:730-731. 4. Quigley HA, Dunkelberger GR, Green WR. Studies of retinal ganglion cell atrophy correlated with automated perimetry in human eyes with glaucoma . Am J Ophthalmol . 1989;107:453-464. 5. Hoyt WF, Newman NM. The earliest observable defect in glaucoma? Lancet . 1972;1:692-693.Crossref 6. Hoyt WF, Frisen L, Newman NM. Funduscopy of nerve fiber layer defects in glaucoma . Invest Ophthalmol Vis Sci . 1973;12:814-829. 7. Sommer A, Miller NR, Pollack I, Maumenee AE, George T. The nerve fiber layer in the diagnosis of glaucoma . Arch Ophthalmol . 1977;95:2149-2156.Crossref 8. Iwata K, Naba K, Abe H. Typical slit-like retinal nerve fiber layer defect and corresponding scotoma . Acta Soc Ophthalmol Jpn . 1981;85:1791-1803. 9. Airaksinen PJ, Drance SM, Douglas GR, Mawson DK, Nieminen H. Diffuse and localized nerve fiber loss in glaucoma . Am J Ophthalmol . 1984;98:566-571. 10. Airaksinen PJ, Drance SM, Douglas GR, Schulzer M, Wijsman K. Visual field and retinal nerve fiber layer comparisons in glaucoma . Arch Ophthalmol . 1985;103:205-207.Crossref 11. Sommer A, Quigley HA, Robin AL, Miller NR, Katz J, Arkell S. Evaluation of nerve fiber layer assessment . Arch Ophthalmol . 1984;102:1766-1771.Crossref 12. Armaly MF, Krueger DE, Maunder L, et al. Biostatistical analysis of the collaborative glaucoma study, I: summary report of the risk factors for glaucomatous visual-field defects . Arch Ophthalmol . 1980;98:2163-2171.Crossref 13. Tielsch JM, Sommer A, Witt K, Katz J, Royall RM. Blindness and visual impairment in an American urban population: the Baltimore Eye Survey . Arch Ophthalmol . 1990;108:286-290.Crossref 14. Canner JK, Sommer A, Katz J, Enger C. ICEPAC: a user-friendly software package for processing Humphrey Field Analyzer diskettes . Invest Ophthalmol Vis Sci . 1988;29( (suppl) ):356. Abstract. 15. Sommer A, Enger C, Witt K. Screening for glaucomatous field loss with automated threshold perimetry . Am J Ophthalmol . 1987;103:681-684. 16. Enger CL, Sommer A. Recognizing glaucomatous field loss with the Humphrey STATPAC . Arch Ophthalmol . 1987;105:1355-1357.Crossref 17. STATPAC User's Guide . San Leandro, Calif: Allergan Humphrey; 1986. 18. Katz J, Sommer A. Reliability indexes of automated perimetric tests . Arch Ophthalmol . 1988;106:1252-1254.Crossref 19. Miller NR, George TW. Monochromatic (red-free) photography and ophthalmoscopy of the peripapillary retinal nerve fiber layer . Invest Ophthalmol Vis Sci . 1978;17:1121-1124. 20. Sommer A, D'Anna SA, Kues HA, George T. High-resolution photography of the retinal nerve fiber layer . Am J Ophthalmol . 1983;96:535-539. 21. Sommer A. Nerve fiber layer in glaucoma . Ophthalmology . 1989;96:639-641. 22. Quigley HA, Sommer A. How to use nerve fiber layer examination in the management of glaucoma . Trans Am Ophthalmol Soc . 1987;85:254-272. 23. Quigley HA. Quantitative studies of retinal nerve fiber layer loss in monkey and human glaucoma . Trans Am Ophthalmol Soc . 1986;84:920-966. 24. Quigley HA, Addicks EM. Quantitative studies of retinal nerve fiber layer defects . Arch Ophthalmol . 1982;100:807-814.Crossref 25. Sommer A, Miller NR, Quigley H, Robin A, Katz J, Burkhard K. Assessment of the nerve fiber layer as a predictor of glaucoma . Invest Ophthalmol Vis Sci . 1985;26( (suppl) ):122. Abstract. 26. Airaksinen PJ, Mustonen E, Alanko HI. Optic disc haemorrhages precede retinal nerve fibre layer defects in ocular hypertension . Acta Ophthalmol . 1981;51:627-641. 27. Weinreb RN, Dreher AW, Coleman A, Quigley H, Sharo B, Reiter K. Histopathologic validation of Fourier-Ellipsometry measurements of retinal nerve fiber layer thickness . Arch Ophthalmol . 1990;108:557-560.Crossref 28. Caprioli J, Miller JM. Measurement of relative nerve fiber layer surface height in glaucoma . Ophthalmology . 1989;96:633-639.Crossref 29. Enger C, Sommer A. Automated threshold perimetry before glaucomatous field loss in eyes with ocular hypertension . Invest Ophthalmol Vis Sci . 1990;31( (suppl) ):432. Abstract. 30. Katz J, Sommer A. Similarities between the visual fields of ocular hypertensive and normal eyes . Arch Ophthalmol . 1986;104:1648-1651.Crossref 31. Diehl DLC, Quigley HA, Miller NR, Sommer A, Burney EN. Prevalence and significance of optic disc hemorrhage in a longitudinal study of glaucoma . Arch Ophthalmol . 1990;108:545-550.Crossref
Archives of Ophthalmology – American Medical Association
Published: Jan 1, 1991
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