The thickest RNFL measurements were found in the inferior quadrant, followed by the superior, nasal, and temporal quadrants (ISNT rule applied to the RNFL). Thinner RNFL measurements were associated with older age and increasing myopia. Caucasians tend to have thinner RNFL values when compared with Hispanics and Asians. SD-OCT analysis of the normal RNFL showed results similar to time domain OCT studies.
Subanalysis and quantification of OCT features in eyes with DME seem to be of value. In particular, POS thickness seems to be an important predictor of function and visual acuity in patients with DME.
Purpose
To determine the retinal nerve fiber layer (RNFL) thickness at which visual field (VF) damage becomes detectable and associated with structural loss.
Design
Retrospective cross-sectional study.
Methods
Eighty seven healthy and 108 glaucoma subjects (one eye per subject) were recruited from an academic institution. All patients had VF examinations (Swedish Interactive Threshold Algorithm 24-2 test of the Humphrey visual field analyzer 750i; Carl Zeiss Meditec, Dublin, CA) and spectral domain optical coherence tomography RNFL scans (Spectralis, Heidelberg Engineering, Heidelberg, Germany). Comparison of RNFL thicknesses values with VF threshold values showed a plateau of VF threshold values at high RNFL thickness values and then a sharp decrease at lower RNFL thickness values. A broken stick statistical analysis was utilized to estimate the tipping point at which RNFL thickness values are associated with VF defects. The slope for the association between structure and function was computed for data above and below the tipping point.
Results
The mean RNFL thickness value that was associated with initial VF loss was 89 μm. The superior RNFL thickness value that was associated with initial corresponding inferior VF loss was 100 μm. The inferior RNFL thickness value that was associated with initial corresponding superior VF loss was 73 μm. The differences between all the slopes above and below the aforementioned tipping points were statistically significant (p<0.001).
Conclusions
In open angle glaucoma, substantial RNFL thinning or structural loss appears to be necessary before functional visual field defects become detectable.
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