Glaucomatous damage of the macula

Abstract

There is a growing body of evidence that early glaucomatous damage involves the macula. The anatomical basis of this damage can be studied using frequency domain optical coherence tomography (fdOCT), by which the local thickness of the retinal nerve fiber layer (RNFL) and local retinal ganglion cell plus inner plexiform (RGC+) layer can be measured. Based upon averaged fdOCT results from healthy controls and patients, we show that: 1. For healthy controls, the average RGC+ layer thickness closely matches human histological data; 2. For glaucoma patients and suspects, the average RGC+ layer shows greater glaucomatous thinning in the inferior retina (superior visual field (VF)); and 3. The central test points of the 6° VF grid (24-2 test pattern) miss the region of greatest RGC+ thinning. Based upon fdOCT results from individual patients, we have learned that: 1. Local RGC+ loss is associated with local VF sensitivity loss as long as the displacement of RGCs from the foveal center is taken into consideration; and 2. Macular damage is typically arcuate in nature and often associated with local RNFL thinning in a narrow region of the disc, which we call the macular vulnerability zone (MVZ). According to our schematic model of macular damage, most of the inferior region of the macula projects to the MVZ, which is located largely in the inferior quadrant of the disc, a region that is particularly susceptible to glaucomatous damage. A small (cecocentral) region of the inferior macula, and all of the superior macula (inferior VF), project to the temporal quadrant, a region that is less susceptible to damage. The overall message is clear; clinicians need to be aware that glaucomatous damage to the macula is common, can occur early in the disease, and can be missed and/or underestimated with standard VF tests that use a 6° grid, such as the 24-2 VF test.

Macular ganglion cell-inner plexiform layer defect patterns in multiple sclerosis patients without optic neuritis: A Spectral-Domain-Optical Coherence Tomography Cross-Sectional, Case-Control, Pilot Study

“…In glaucoma patients, the most frequent defect in those with the early and moderate disease was the inferior confined type (21.9% and 50.0%, respectively), and in those with advanced disease the diffuse severe type (59.1%). These results were in agreement with previous reports, 41–44 including a study by Hood et al 50 showing that the inferior macula, in which the axons project towards the inferior side of the optic nerve together with the axons of the inferior retina, is more vulnerable to damage in the early stage of glaucoma.…”

Macular ganglion cell-inner plexiform layer defect patterns in multiple sclerosis patients without optic neuritis: A Spectral-Domain-Optical Coherence Tomography Cross-Sectional, Case-Control, Pilot Study

“…In glaucoma patients, the most frequent defect in those with the early and moderate disease was the inferior confined type (21.9% and 50.0%, respectively), and in those with advanced disease the diffuse severe type (59.1%). These results were in agreement with previous reports, 41–44 including a study by Hood et al 50 showing that the inferior macula, in which the axons project towards the inferior side of the optic nerve together with the axons of the inferior retina, is more vulnerable to damage in the early stage of glaucoma.…”

Comparison of glaucoma diagnostic ability of ganglion cell-inner plexiform layer according to the range around the fovea

“…The inferotemporal GCIPL parameters in the present study also showed high AUROCs for the detection of glaucoma. These results are in agreement with prior results, which suggested that the inferotemporal area of the macula is the most vulnerable papillomacular bundle area to glaucomatous damage [14, 17, 19, 22, 23]. Furthermore, Hood et al speculated that the vulnerable area to damage in glaucoma is a part of the high-density axon region and that the probability of glaucomatous damage is proportional to the axon density, which is known as the crowding hypothesis [3, 17, 18].…”

“…These results are in agreement with prior results, which suggested that the inferotemporal area of the macula is the most vulnerable papillomacular bundle area to glaucomatous damage [14, 17, 19, 22, 23]. Furthermore, Hood et al speculated that the vulnerable area to damage in glaucoma is a part of the high-density axon region and that the probability of glaucomatous damage is proportional to the axon density, which is known as the crowding hypothesis [3, 17, 18]. Takayama et al similarly proposed that the papillomacular bundle is typically spared until advanced glaucoma damage occurs, and that the retinal ganglion cells in the nasal macular area are less susceptible to glaucoma than those in the temporal side to the macula [14].…”

Factors Related to Superior and Inferior Hemifield Defects in Primary Open-Angle Glaucoma

“…We also found that the mGCC thicknesses corresponding to the defective hemifields of the superior VF defect group were significantly thinner than the superior mGCC thicknesses corresponding to the defective hemifield of the inferior VF defect group (Table 2). These findings support the findings by Hood et al [24, 25].…”

Macular ganglion cell-inner plexiform layer defect patterns in multiple sclerosis patients without optic neuritis: A Spectral-Domain-Optical Coherence Tomography Cross-Sectional, Case-Control, Pilot Study

“…In glaucoma patients, the most frequent defect in those with the early and moderate disease was the inferior confined type (21.9% and 50.0%, respectively), and in those with advanced disease the diffuse severe type (59.1%). These results were in agreement with previous reports, 41–44 including a study by Hood et al 50 showing that the inferior macula, in which the axons project towards the inferior side of the optic nerve together with the axons of the inferior retina, is more vulnerable to damage in the early stage of glaucoma.…”

Comparison of glaucoma diagnostic ability of ganglion cell-inner plexiform layer according to the range around the fovea

“…The inferotemporal GCIPL parameters in the present study also showed high AUROCs for the detection of glaucoma. These results are in agreement with prior results, which suggested that the inferotemporal area of the macula is the most vulnerable papillomacular bundle area to glaucomatous damage [14, 17, 19, 22, 23]. Furthermore, Hood et al speculated that the vulnerable area to damage in glaucoma is a part of the high-density axon region and that the probability of glaucomatous damage is proportional to the axon density, which is known as the crowding hypothesis [3, 17, 18].…”

“…These results are in agreement with prior results, which suggested that the inferotemporal area of the macula is the most vulnerable papillomacular bundle area to glaucomatous damage [14, 17, 19, 22, 23]. Furthermore, Hood et al speculated that the vulnerable area to damage in glaucoma is a part of the high-density axon region and that the probability of glaucomatous damage is proportional to the axon density, which is known as the crowding hypothesis [3, 17, 18]. Takayama et al similarly proposed that the papillomacular bundle is typically spared until advanced glaucoma damage occurs, and that the retinal ganglion cells in the nasal macular area are less susceptible to glaucoma than those in the temporal side to the macula [14].…”

Factors Related to Superior and Inferior Hemifield Defects in Primary Open-Angle Glaucoma

“…We also found that the mGCC thicknesses corresponding to the defective hemifields of the superior VF defect group were significantly thinner than the superior mGCC thicknesses corresponding to the defective hemifield of the inferior VF defect group (Table 2). These findings support the findings by Hood et al [24, 25].…”

Macular ganglion cell-inner plexiform layer defect patterns in multiple sclerosis patients without optic neuritis: A Spectral-Domain-Optical Coherence Tomography Cross-Sectional, Case-Control, Pilot Study

“…In glaucoma patients, the most frequent defect in those with the early and moderate disease was the inferior confined type (21.9% and 50.0%, respectively), and in those with advanced disease the diffuse severe type (59.1%). These results were in agreement with previous reports, 41–44 including a study by Hood et al 50 showing that the inferior macula, in which the axons project towards the inferior side of the optic nerve together with the axons of the inferior retina, is more vulnerable to damage in the early stage of glaucoma.…”

Comparison of glaucoma diagnostic ability of ganglion cell-inner plexiform layer according to the range around the fovea

“…The inferotemporal GCIPL parameters in the present study also showed high AUROCs for the detection of glaucoma. These results are in agreement with prior results, which suggested that the inferotemporal area of the macula is the most vulnerable papillomacular bundle area to glaucomatous damage [14, 17, 19, 22, 23]. Furthermore, Hood et al speculated that the vulnerable area to damage in glaucoma is a part of the high-density axon region and that the probability of glaucomatous damage is proportional to the axon density, which is known as the crowding hypothesis [3, 17, 18].…”

“…These results are in agreement with prior results, which suggested that the inferotemporal area of the macula is the most vulnerable papillomacular bundle area to glaucomatous damage [14, 17, 19, 22, 23]. Furthermore, Hood et al speculated that the vulnerable area to damage in glaucoma is a part of the high-density axon region and that the probability of glaucomatous damage is proportional to the axon density, which is known as the crowding hypothesis [3, 17, 18]. Takayama et al similarly proposed that the papillomacular bundle is typically spared until advanced glaucoma damage occurs, and that the retinal ganglion cells in the nasal macular area are less susceptible to glaucoma than those in the temporal side to the macula [14].…”

Factors Related to Superior and Inferior Hemifield Defects in Primary Open-Angle Glaucoma

“…We also found that the mGCC thicknesses corresponding to the defective hemifields of the superior VF defect group were significantly thinner than the superior mGCC thicknesses corresponding to the defective hemifield of the inferior VF defect group (Table 2). These findings support the findings by Hood et al [24, 25].…”