(1)Journal of the Korean Glaucoma Society

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(1)Journal of the Korean Glaucoma Society 2017;6(2):39-48. Original Article. ࡻௐ੭‫૲ڂ‬੥३ӄࣼ੭௖࡚ࣴਁઅഡ‫ֳפ‬ણઅӴ૒હԞ‫؟‬હࣛӚӚӆ Structure-function Relationship in Glaucoma Assessed Using Nasal Peripapillary Retinal Nerve Fiber Layer Thickness Measurements 유은주, 유정권, 김용연 Eunjoo Yoo, MD1, Chungkwon Yoo, MD, PhD2, Yong Yeon Kim, MD, PhD2 ᮁ฾ᦩŝ᮹ᬱ Łಅ‫⦺ݡ‬Ʊ᮹ŝ‫ᦩ⦺ݡ‬ŝ⦺Ʊᝅ 1. Yoo-mang Eye Clinic, Seoul, Korea Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea. 2. Purpose: To evaluate the structure-function relationships using the average retinal nerve fiber layer thickness (RNFLT) and the nasal RNFLT in primary open-angle glaucoma (OAG) patients. Methods: This retrospective study included 283 OAG patients and 44 normal controls. The average RNFLT was defined as the mean of the 360° of peripapillary RNFLT, and the nasal RNFLT as the average of the peripapillary RNFLT from 1 o’clock to 5 o’clock directions. The structure-function relationships between the average or nasal RNFLT and the mean deviation (MD) of corresponding visual field (VF) were assessed by regression analyses. The R package named ‘segmented’ was used to investigate whether there was a statistically significant breakpoint. Results: The relationship between the MD and the average RNFLT was better explained in glaucoma patients by a second-order polynomial regression model than a linear model (both p < 0.001, adjusted-R 2 = 0.646 and R 2 = 0.623, respectively). The MD value of -16.29 dB was identified as the significant breakpoint. For the nasal RNFLT, a second-order polynomial model did not fit better than the linear model (both p < 0.001, adjusted-R 2 = 0.209 and R 2 = 0.381, respectively), with no statistically significant breakpoint. Conclusions: The nasal RNFLT did not have a breakpoint but showed a continual decrease even at the advanced stage of glaucoma, whereas the average RNFLT had a breakpoint over which no further thinning could be observed despite further VF loss. These findings suggest the potential of the nasal peripapillary RNFLT as a useful marker to monitor the progression in advanced glaucoma. Key words: Retinal nerve fiber layer thickness, Open-angle glaucoma.. Introduction.

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(18) '4-6 The. Received: 2017. 10. 10. Accepted: 2017. 11. 14.. Revised: 2017. 11. 4.. Corresponding Author: Chungkwon Yoo, MD, PhD Department of Ophthalmology, Korea University College of Medicine, #73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea Tel: +82-2-920-5520, Fax: +82-2-924-6820 E-mail: ckyoomd@korea.ac.kr. www.koreanglaucoma.org.

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(255) . Figure 1. Clock hour directions of the right and left optic nerves. The twelve sectors of 30° each were defined clockwise for the right eyes and counterclockwise for the left eyes. H = hour.. www.koreanglaucoma.org.

(256) 42. JOURNAL OF THE KOREAN GLAUCOMA SOCIETY. 9ROXPH_1XPEHU. Package for the Social Science version 22.0 (IBM Corp.,. at a level of p «^'^

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(367) . Table 1. Demographics and clinical characteristics of the normal control and glaucoma patients. Normal (n = 44). Glaucoma (n = 283) Mild (n = 119). Moderate (n = 74). Advanced (n = 90). p -value. 54.80 ± 10.47. 54.89 ± 14.26. 59.76 ± 14.02. 62.77 ± 12.96. <0.001*. 8 (22.2). 55 (46.2). 31 (41.9). 32 (35.6). 0.158†. 14.0 ± 2.5. 16.6 ± 3.2. 18.4 ± 6.2. 18.9 ± 7.7. 0.011*. Central corneal thickness (`m). 536.50 ± 32.98. 524.80 ± 33.81. 518.48 ± 75.20. 518.67 ± 39.32. 0.323*. Spherical equivalent (diopters). -0.37 ± 1.34. -0.93 ± 2.16. -0.75 ± 2.99. -0.98 ± 2.14. 0.821*. Mean deviation (dB). -0.98 ± 1.53. -2.41 ± 1.70. -8.05 ± 1.45. -21.62 ± 6.09. <0.001*. 2.11 ± 1.15. 3.30 ± 2.00. 8.72 ± 3.48. 11.11 ± 4.06. <0.001*. 99.08 ± 0.97. 95.99 ± 4.71. 81.83 ± 8.27. 33.47 ± 21.08. <0.001*. Age (years) Female (n, %) Intraocular pressure (mmHg). Pattern standard deviation (dB)

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(369) . Values are presented as mean ± SD or n (%) unless otherwise indicated. no. = number; dB = decibel. *Comparison of the mild, moderate and advanced glaucoma groups by one-way analysis of variance (ANOVA); †Comparison of the mild, moderate and advanced glaucoma groups by chi-square test.. Journal of the Korean Glaucoma Society.

(370) E Yoo, et al. : Nasal RNFL thicknesses in glaucoma. 43. Table 2. Peripapillary retinal nerve fiber layer thickness of the normal control and glaucoma patients. Normal (n = 44) Average RNFLT (μm). Glaucoma (n = 283) Mild (n = 119). Moderate (n = 74). Advanced (n = 90). p -value* Post Hoc test†. 112.14 ± 7.90. 104.11 ± 10.91. 94.59 ± 10.55. 72.69 ± 10.27. <0.001. A>B>C. 101.68 ± 13.04. 101.89 ± 15.49. 92.57 ± 13.68. 75.58 ± 12.96. <0.001. A>B>C. H1. 126.75 ± 18.57. 114.41 ± 17.91. 107.85 ± 20.65. 83.19 ± 20.20. <0.001. A>B>C. H2. 106.98 ± 17.62. 107.30 ± 21.55. 94.59 ± 19.73. 80.23 ± 18.30. <0.001. A>B>C. ‡. Nasal RNFLT RNFLT of clock-hour sectors (`m). H3. 77.46 ± 11.68. 82.19 ± 16.31. 78.41 ± 14.25. 72.32 ± 15.51. <0.001. A=B>C. H4. 82.27 ± 17.19. 89.52 ± 18.94. 80.61 ± 17.74. 68.90 ± 16.90. <0.001. A>B>C. H5. 114.93 ± 22.61. 116.02 ± 24.16. 101.38 ± 19.24. 73.23 ± 18.78. <0.001. A>B>C. H6. 144.98 ± 18.67. 132.03 ± 30.80. 112.14 ± 30.43. 71.29 ± 20.94. <0.001. A>B>C. H7. 146.98 ± 22.56. 116.82 ± 27.86. 98.09 ± 31.17. 66.57 ± 19.91. <0.001. A>B>C. H8. 87.09 ± 15.27. 79.71 ± 17.02. 76.61 ± 15.62. 64.70 ± 17.53. <0.001. A=B>C. H9. 75.80 ± 11.78. 72.66 ± 12.74. 75.54 ± 15.78. 66.46 ± 16.31. <0.001. A=B>C. H10. 96.23 ± 20.79. 93.16 ± 16.78. 89.81 ± 20.73. 65.67 ± 18.88. <0.001. A=B>C. H11. 143.48 ± 17.28. 125.81 ± 21.18. 110.59 ± 24.90. 77.49 ± 21.95. <0.001. A>B>C. H12. 138.66 ± 20.63. 120.62 ± 20.73. 109.92 ± 23.67. 82.21 ± 21.72. <0.001. A>B>C. Values are presented as n (%) unless otherwise indicated.

(371) * Comparison of the mild, moderate and advanced glaucoma groups by one-way analysis of variance (ANOVA); †Least post hoc test was performed to compare differences among the mild (A), moderate (B), and advanced (C) ‡ glaucoma groups; ! " "#$&$'$+/"0" ". A. B. Figure 2. Scatterplots showing the relationships between the mean deviation and (A) the average retinal nerve fiber layer thickness (RNFLT) and (B) the nasal RNFLT. The dotted line in (A) indicates the breakpoint of -16.290 dB.. assessed using a simple linear regression model (p < 0.001, 2.

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(393) 44. JOURNAL OF THE KOREAN GLAUCOMA SOCIETY. 9ROXPH_1XPEHU. Table 3. Comparisons of demographics and retinal nerve fiber layer thickness among the four quartile groups of glaucoma patients with. mean deviation values lower than the breakpoint. Age (years) Female (n, %). 1st quartile (n = 16). 2nd quartile (n = 17). 3rd quartile (n = 17). 4th quartile (n = 16). p -value. 65.69 ± 12.37. 66.29 ± 10.87. 59.35 ± 15.65. 61.88 ± 9.93. 0.330*. 4 (25.0). 9 (52.9). 7 (41.2). 4 (25.0). 0.264†. Intraocular pressure (mmHg). 22.69 ± 12.76. 21.12 ± 9.54. 16.88 ± 3.35. 16.19 ± 3.97. 0.080*. Central corneal thickness (`m). 517.37 ± 37.95. 507.65 ± 42.90. 524.38 ± 35.94. 516.38 ± 41.15. 0.720*. Spherical equivalent (diopters). -0.49 ± 1.97. -0.63 ± 1.93. -1.38 ± 1.99. -0.91 ± 2.27. 0.647*. -30.13 ± 1.04. -26.69 ± 0.95. -22.56 ± 1.66. -17.93 ± 1.05. <0.001*. Pattern standard deviation (dB). 4.57 ± 2.05. 9.60 ± 1.75. 12.91 ± 2.59. 13.93 ± 1.83. <0.001*.

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(395) . 4.94 ± 4.15. 19.18 ± 5.82. 28.59 ± 6.87. 42.44 ± 1.61. <0.001*. Average RNFLT (`m). 68.81 ± 7.98. 66.88 ± 7.11. 74.24 ± 11.00. 73.44 ± 10.85. 0.076*. Nasal RNFLT (`m). 69.20 ± 9.12. 71.01 ± 9.91. 77.39 ± 11.09. 80.91 ± 16.48. 0.023*. Mean deviation (dB). Values are presented as mean ± SD or n (%) unless otherwise indicated. !

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(602) '. than that reported in a previous study. There are some pos-. By contrast to the average RNFLT, the nasal RNFLT did. sible explanations for such discrepancies. First, most of the. not have a breakpoint for corresponding VF MD deteri-.

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(657) 46. JOURNAL OF THE KOREAN GLAUCOMA SOCIETY. 9ROXPH_1XPEHU. evaluation of the nasal RNFLT may be more helpful to de-. fore, the exact changing patterns of the average RNFLT. termine glaucoma progression than the average RNFLT in. and the nasal RNFLT need to be assessed by further lon-.

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(685) . rim is located mainly in the nasal sector of optic discs in. not taken into account on patient enrollment. The patients at. advanced glaucoma patients.. advanced stage of glaucoma might have had different visual. One may doubt that the nasal RNFLT is useless for mon-.

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(689) -. itoring glaucoma progression, because the nasal sector. ral-sparing even if they had the same VF MD values. The. naturally contains a lesser component of nerve fibers and. pattern of change of the nasal RNFLT might vary depend-. non-neural tissues comprise a large proportion of it. The. ing on the existence of temporal-sparing. Fourth, although.

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