Diffuse Glaucomatous Structural and Functional Damage in the Hemifield Without Significant Pattern Loss

Objectives: To compare the retinal nerve fiber layer (RNFL) thickness and retinal sensitivity in the normal visual hemifield of glaucomatous eyes with localized visual field loss with those of normal eyes and eyes with suspected glaucoma, and to evaluate the relationship between RNFL atrophy and glaucoma severity. Methods: One randomly selected eye of each subject underwent standard automated perimetry, stereoscopic photography, scanning laser polarimetry with enhanced corneal compensation, and time-domain and spectral-domain optical coherence tomography (OCT). Mean retinal sensitivity values were calculated in the normal standard automated perimetry hemifield of the glaucoma group and randomly selected hemifields in the normal and suspected glaucoma groups. The mean RNFL thickness values corresponding to the normal hemifield were calculated. Glaucoma severity was judged using standard automated perimetry pattern standard deviation and the Heidelberg retina tomograph-derived linear cupdisc ratio. Results: Fifty subjects were enrolled in each group. Mean RNFL thickness in the normal hemifield obtained using spectral-domain OCT, time-domain OCT, and scanning laser polarimetry with enhanced corneal compensation was significantly (P <=.01) thinner in the glaucoma group compared with the normal and suspected glaucoma groups. Mean retinal sensitivity in the normal hemifield was significantly (P<.001) reduced in the glaucoma group compared with the normal and suspected glaucoma groups. The Heidelberg retina tomograph-derived cup-disc ratio was significantly correlated with mean RNFL thickness in the normal hemifield obtained using spectral-domain OCT, time-domain OCT, and scanning laser polarimetry with enhanced corneal compensation (P <=.01). Conclusions: Diffuse RNFL atrophy and retinal sensitivity loss exist in glaucomatous eyes with localized standard automated perimetry deficits. Glaucomatous damage affects both structure and function in a linear proportion.