Glaucoma is characterized by progressive optic nerve head (ONH) deformation and retinal nerve fiber layer (RNFL) thinning but the relative sequence of ONH and RNFL changes in glaucoma remains largely uncertain. It has been proposed that structural damage of the optic nerve can often be detected before detectable functional loss. Therefore, investigating structural changes of the ONH and RNFL is of importance and relevance in the monitoring and management of glaucoma progression. Spectral domain optical coherence tomography (OCT), scanning laser polarimetry (SLP) and confocal scanning laser ophthalmoscopy (CSLO) are the three prevailing digital imaging technologies for measurement of RNFL thickness, RNFL retardance and ONH parameters, respectively. Although these instruments have been extensively investigated for detection of glaucomatous damage, less is known about their relative performance for detection of change in glaucoma progression. Although previous studies on non- human primates showed that disruption of the microtubule structure of the retinal ganglion cell axons detected by SLP as reduction of RNFL retardance, as well as ONH surface deformation detected by CSLO, could be detected prior to reduction of RNFL thickness measured with OCT, clinical data corroborating this observation are lacking. The sequence of change of RNFL thickness, RNFL retardance and ONH parameters has not been investigated in human glaucoma. / This research project aimed to investigate the performance of OCT, SLP and CLSO for change detection of RNFL and ONH damages, determine the relative sequence of change of RNFL retardance and RNFL thickness and ONH deformation, and evaluate if ocular biomechanical properties, measured as corneal hysteresis by the ocular response analyzer (ORA, Reichert Inc.), influence the detection of ONH and RNFL progression in glaucoma patients. We hypothesized that ONH deformation and loss of RNFL retardance could be detected before detectable RNFL thinning and that the baseline corneal hysteresis would be a risk factor for ONH and RNFL damage in glaucoma. / In the first study, we analyzed 184 eyes of 116 patients with glaucoma and 43 normal eyes of 23 healthy individuals followed for a mean of 4.6 years. All subjects had RNFL retardance and RNFL thickness measurements obtained with GDx ECC (Carl Zeiss Meditec) and Cirrus HD-OCT (Carl Zeiss Meditec), respectively, at 4-month intervals. Progressive reduction of RNFL retardance and RNFL thickness were evaluated with Guided Progression Analysis (GPA, Carl Zeiss Meditec) with reference to the RNFL retardance change map and RNFL thickness change map, respectively. Twenty seven eyes of 26 patients showed progressive RNFL thinning whereas 8 eyes of 8 patients had RNFL retardance reduction in the latest follow-up visit. Seven eyes of 7 patients had progressive RNFL thinning and reduction of RNFL retardance detected by both instruments; all had progressive RNFL thinning evident before reduction of RNFL retardance and the mean lag time was 13.4 months (range: 4.0-37.6 months). The survival time of eyes detected with RNFL thinning was significantly shorter than the survival time of eyes detected with reduction of RNFL retardance (P=0.001). No eyes in the normal group showed progressive RNFL changes during follow-up. Collectively, we showed that at a comparable specificity (100%, 95% confidence interval: 96.3%-100%), progressive RNFL thinning was detected more often than progressive reduction of RNFL retardance and the former preceded the latter in eyes with both progressive RNFL thinning and reduction of RNFL retardance. / In the second study using a similar study design, we investigated the sequence of change of ONH surface depression detected by CSLO (HRT 3, Heidelberg Engineering) and RNFL thinning detected by OCT (Cirrus HD-OCT, Carl Zeiss Meditec) in 146 eyes of 90 glaucoma patients followed at approximately 4-month intervals for an average of 5.4 years. Significant ONH surface depression and RNFL thinning were defined with reference to Topographic Change Analysis (TCA, Heidelberg Engineering) and Guided Progression Analysis (GPA, Carl Zeiss Meditec), respectively. At a specificity of 94.3% (95% confidence interval: 86.2%-97.8%) for both RNFL thinning and ONH surface depression (determined in a normal group comprising 70 eyes from 35 normal subjects), 57 eyes (39.0%) had ONH surface depression, 46 eyes (31.5%) had RNFL thinning, and 23 eyes (15.8%) had both in the glaucoma group. Among these 23 eyes, 19 (82.6%) had ONH surface depression detected prior to RNFL thinning and the median lag time was 15.8 months (range, 4.0-40.8 months). Although only 7.0% of eyes (4/57) had RNFL thinning at the onset of ONH surface depression, 45.7% (21/46) had ONH surface depression at the onset of RNFL thinning. The survival time of eyes with ONH surface depression was significantly shorter than the survival time of eyes detected with RNFL thinning (P=0.002). With reference to the HRT TCA and OCT GPA, ONH surface depression occurred before RNFL thinning in a significant proportion of patients with glaucoma at a comparable specificity. / Of note, a significant proportion of eyes had ONH surface depression without any detectable progressive RNFL thinning in the second study, and vice versa. Investigating whether the risk factors for ONH surface depression and RNFL progression are different is therefore important. In the final study, we investigated if baseline corneal hysteresis is a risk factor for progressive ONH surface depression and RNFL thinning. Following the same cohort of 146 eyes of 90 glaucoma patients for an average of 6.8 years, we detected that 65 eyes (44.5%) had progressive ONH surface depression, 55 eyes (37.7%) had progressive RNFL thinning and 20 eyes (13.7%) had visual field progression (based on the EMGT criteria). After adjusting for ages, CCT, baseline diastolic IOP, average IOP during follow-up, baseline disc area and baseline MD in the cox proportional hazards model, baseline corneal hysteresis was significantly associated with ONH surface depression (HR=0.70, P=0.008), visual field progression (HR=0.56, P=0.019), but not with progressive RNFL thinning (HR=0.96, P=0.751). For each 1-mmHg decrease of baseline CH, the hazards for ONH surface depression and visual field progression increased by 30% and 44%, respectively. / In summary, at a comparable level of specificity, progressive ONH surface depression detected by CSLO could be observed prior to progressive RNFL thinning detected by OCT, which preceded identified reduction of RNFL retardance detected by SLP. For eyes with concomitant ONH surface depression, RNFL thinning and visual field progression, ONH surface depression always preceded visual field progression. Our finding indicates that a time window for therapeutic intervention may exist upon detection of ONH surface depression before irreversible RNFL and visual field loss and that measurement of CH would be useful to predict ONH surface depression and visual field progression. / Further studies are required to investigate the sequence of optic nerve head change and RNFL progression with the same instrument. Whether IOP lowering treatment initiated at the time of ONH deformation would be effective to prevent or slow down RNFL and visual field loss needs to be further investigated. A more reliable and accurate measure of the ocular biomechanical properties is necessary for evaluation of their contribution to glaucoma progression. / 青光眼是一種進展性視神經病變，其特徵為﹕視神經乳頭變形，神經纖維層（RNFL）的變薄以及相應的視野缺損。然而，青光眼結構性改變和功能性變化發生的相對順序仍不清楚。視神經結構性改變被認為要早於功能性改變的發生。因此，研究視乳頭的結構性改變具有重要意義，有助於早期診斷青光眼的進展及隨訪青光眼患者。目前主要用於RNFL厚度，RNFL阻滯性以及視乳頭參數的影像學掃描儀器為頻域OCT，鐳射偏振光掃描器（SLP）和共聚焦鐳射掃描眼底鏡（CSLO）。儘管這三種儀器已經廣泛用於青光眼損傷的檢測，但在青光眼患者結構性變化的應用並不常見。既往在非人靈長類動物的實驗中，通過破壞神經節細胞軸突中的微小管結構，從而發現RNFL的阻滯性以及視乳頭的變化要先於RNFL厚度變化的發生。然而在臨床研究中並未得到證實。同時，在青光眼患者中，RNFL厚度變化，RNFL阻滯減少以及視神經頭參數改變之間的先後順序並未得到證實。 / 本次實驗研究的目的在於探討OCT，SLP及CSLO在診斷青光眼病人RNFL及視乳頭進展的能力，確定RNFL厚度變化，RNFL阻滯性減少以及視神經頭參數改變之間的相對順序，以及評估眼反應分析儀（ORA）測得的角膜粘滯性（CH）是否影響視乳頭及RNFL厚度的進展。我們假設：視神經乳頭的變形，RNFL阻滯性的減少要先於RNFL厚度的變化，基線角膜粘滯性的測量會影響視乳頭及RNFL進展的檢測。116個青光眼病人的184隻眼以及23個正常對照的43隻眼被納入第一個研究中。所有受試物件均接受每4個月一次的OCT以及SLP RNFL的掃描，平均隨訪時間為4.6年。通過OCT及SLP中Guided Progression Analysis（GPA, Carl Zeiss Meditec）程式，一系列RNFL厚度及粘滯性圖被自動分析從而獲得RNFL厚度及粘滯性的變化結果。26個青光眼患者的27隻眼表現為RNFL厚度的進行性變薄，8個患者的8隻眼表現為RNFL粘滯性的減少。其中7個患者的7隻眼同時表現為RNFL厚度變薄及粘滯性的減少，所有這7隻眼的RNFL變薄的發生要早於RNFL粘滯性的減少，兩者間隔時間平均為13.4月（4.0-37.6月）。RNFL厚度變薄者的生存概率明顯小於RNFL粘滯性減少的青光眼患者（P=0.001）。隨訪中，我們未發現正常對照組中RNFL厚度變薄或者粘滯性改變者。總體說來，在同一特異性水準（100%），RNFL厚度的變化頻率高於粘滯性的改變，RNFL厚度的變薄要早於粘滯性減少的發生。 / 採用相同於第一個研究的研究方法，我們研究CSLO測得的視乳頭表面凹陷以及測得OCT的RNFL厚度變化發生的相對順序。90個青光眼患者的146隻眼以及35個正常對照物件的70隻眼被納入第二個研究中。所有受試物件均接受4個月一次的CSLO及OCT掃描從而獲得一系列的視神經頭表面的拓撲圖像以及RNFL厚度圖。CSLO TCA及OCT GPA程式自動對比基線及隨訪中所獲得的視神經頭表面的拓撲圖像以及RNFL厚度圖，從而獲得視乳頭表面凹陷及RFNL進展報告。平均隨訪5.4年後，CSLO及OCT在診斷視神經頭及RNFL進展的特異性為94.3%，57只青光眼患眼（39.0%）表現為顯著性視乳頭表面凹陷，46隻眼（31.5%）表現為RFNL厚度的進行性變薄，而23隻眼（15.8%）同時表現為視乳頭面凹陷和RFNL的進行性變薄。在這23只眼中，19隻眼（82.6%）變現為視乳頭表面凹陷先於RFNL厚度變薄的發生，間隔時間的中值為15.8個月（4.0-40.8月）。儘管在顯著性視乳頭表面凹陷發生時，僅有7.0%的患眼表現為RNFL厚度的變薄；但是，在RNFL厚度發生顯著性變薄時已有45.7%的患眼表現為視乳頭表面凹陷。視乳頭表面凹陷患眼的生存概率差於RNFL厚度變薄患眼（P=0.002）。在青光眼患者的隨訪中，CLSO TCA測得的視乳頭表面凹陷要早於OCT GPA測得的RNFL厚度的變化。 / 最後的一個研究目在於評估眼反應分析儀（ORA）測得的基線角膜粘滯性（CH）是否為視乳頭表面凹陷及RNFL厚度變薄的危險因素。平均隨訪同一人群即第二個研究中的90個青光眼患者的146眼6.8年，65隻眼（44.5%）被檢測出具有進行性視乳頭表面凹陷，55隻眼（37.7%）表現為進行性RNFL厚度的變薄，20隻眼（13.7%）表現為進行性視野的缺損（基於EMGT標準）。基線CH與視乳頭表面凹陷，視野進展間具有顯著性相關關係（HR=0.70，P=0.008及HR=0.56，P=0.019），但CH與進行性RNFL厚度變薄間並無顯著性相關關係（HR=0.96，P=0.751）。每1毫米汞柱基線CH的降低，發生視乳頭表面凹陷及視野缺損的危險性將增加30%及44%。CH的測量值與青光眼進展的危險性具有顯著相關關係。 / 總之，在具有可比性特異性水準下，CSLO檢測的進展性視乳頭表面凹陷的發生要先於OCT檢測的進行性RNFL厚度的變薄，後者的發生早於SLP測得的RNFL粘滯性的改變。對於同時有視乳頭表面凹陷，RNFL厚度變薄及RNFL粘滯性改變的青光眼患眼，視乳頭表面凹陷的發生要早於視野的進展。我們的實驗研究表明了在青光眼患者發生視乳頭表面凹陷時，治療的時間窗的存在有助於避免不可逆的RNFL缺失及視野的缺損。角膜粘滯性的測量對於預測視乳頭表面凹陷及視野進展具有重要意義。 / 展望未來的研究中，用同一種儀器進行視乳頭及神經纖維層的隨訪，從而得出相對的變化次序很有必要。研究在視乳頭或者神經纖維層發生變化時進行眼壓的干預是否能避免視功能的進一步損傷顯得尤為重要。用於測量角膜生物學特性的更為準確，可信度更高的儀器真正研發中，以及進一步探討角膜生物學特性與青光眼進展之間的關係。 / Xu, Guihua. / Thesis Ph.D. Chinese University of Hong Kong 2015. / Includes bibliographical references (leaves 116-145). / Abstracts also in Chinese. / Title from PDF title page (viewed on 18, October, 2016). / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

Objetivos: Analisar o potencial da oftalmoscopia confocal de varredura a laser, através do Heidelberg Retina Tomograph (HRT), para predizer o risco de progressão em pacientes com suspeita de glaucoma. Comparar os resultados obtidos com o índice de probabilidade de glaucoma (GPS) do HRT aos resultados da análise de regressão de Moorfields (ARM), dos parâmetros morfométricos e da avaliação das fotografias estereoscópicas. Métodos: Uma coorte foi selecionada com 223 pacientes com suspeita de glaucoma, que foram seguidos por um período médio de 64,9 ± 37,3 meses. A suspeita de glaucoma baseou-se na aparência do disco óptico e/ou na pressão intraocular elevada (> 21 mmHg). Todos os participantes apresentavam dois exames de campo visual normais ao entrar no estudo. Conceituou-se progressão como o desenvolvimento de um defeito confirmado de campo visual ou deterioração do disco óptico na avaliação seriada das estereofotografias. A associação entre os resultados do HRT na época do início do acompanhamento e a progressão para glaucoma foi investigada através de modelos de regressão do tipo Cox. Usou-se o C-index para a comparação entre os modelos com os diversos parâmetros do HRT, isolados ou ajustados para os outros já conhecidos fatores de risco para progressão (idade, espessura corneana, pressão intraocular e pattern standard deviation PSD). Resultados: No período do estudo, 46 pacientes (21%) apresentaram progressão. Na análise multivariada, o GPS, a ARM e diversos parâmetros morfométricos foram preditivos para progressão, assim como a avaliação subjetiva das estereofotografias. Cada GPS 0,1 maior foi associado com um aumento de 23% no risco de progressão (C-index de 0,69). Os resultados anormais nas classificações finais do GPS e da ARM foram associados a aumentos de 3 e 2 vezes no risco de progressão, respectivamente (C-indexes de 0,70 e 0,68, respectivamente). O parâmetro com o melhor C-index foi a área seccional tranversa da camada de fibras nervosas (0,72). Uma área 0,3 mm2 menor foi associada a um risco 62% maior de progressão. A comparação do valor preditivo entre os modelos com o GPS e com a avaliação subjetiva das estereofotografias foi similar (C-indexes de 0,69 e 0,68, respectivamente). Conclusão: Nesse estudo observamos que as análises objetivas do disco óptico e da região peripapilar obtidas com o HRT contribuíram na avaliação do risco de progressão em pacientes com suspeita de glaucoma. O GPS mostrou-se tão eficaz quanto os parâmetros morfométricos e a análise de regressão de Moorfields, e a comparação do desempenho dos modelos contendo a avaliação subjetiva das estereofotografias e aqueles contendo a avaliação objetiva pelo GPS não mostrou diferenças significativas / Purpose: To evaluate the ability of baseline confocal scanning laser ophthalmoscopy, using the Heidelberg Retina Tomograph (HRT), in predicting the development of progression in patients suspected of having glaucoma. In addition, the study also aimed to compare the predictive abilities of the glaucoma probability score (GPS) with those of the Moorfields regression analysis (MRA) and stereometric parameters, and to compare the performance of the HRT with that of subjective evaluation of optic disc stereophotographs. Methods: This longitudinal study included a cohort of 223 eyes suspected of having glaucoma, which were followed for an average of 64.9 ± 37.3 months. Included suspects had a suspicious appearance of the optic disc and/or elevated intraocular pressure, but normal visual fields. Progression was defined as the development of either repeatable abnormal visual fields or glaucomatous structural deterioration in the appearance of the optic disc during the study period. The association between baseline HRT parameters and progression was investigated by Cox regression models. The comparison between models with HRT parameters, individually or combined with other known risk factors (age, central corneal thickness, pattern standard deviation and intraocular pressure), performed by comparing their C-indexes. Results: Forty-six (21%) eyes converted during the study period. In multivariable models, the GPS, the MRA, and the stereometric parameters were all predictive of progression. A GPS 0.1 larger was associated with an increase of 23% in the risk of progression (C-index of 0.69). Abnormal final classifications for the GPS or the MRA were associated with a three-fold and two-fold increase in the risk of progression, respectively (with C-indexes of 0.70 and 0.68, respectively). The parameter with the best C-index was the nerve fiber layer cross-sectional area (0.72). An area 0.3 mm2 smaller was associated with a 62% higher risk of an individual progress. The comparison between models with the HRT parameters and those with the subjective stereophotograph evaluation had similar results (C-indexes of 0.69 and 0.68, respectively). Conclusion: In this study, we were able to show that the objective structural assessment of the optic disc and peripapillary area obtained with the HRT was significantly predictive for progression in suspected individuals. The GPS was as predictive as the other HRT parameters, and no significant differences were observed between models with the GPS and those with the subjective assessment of the stereophotographs.

Objetivos: Analisar o potencial da oftalmoscopia confocal de varredura a laser, através do Heidelberg Retina Tomograph (HRT), para predizer o risco de progressão em pacientes com suspeita de glaucoma. Comparar os resultados obtidos com o índice de probabilidade de glaucoma (GPS) do HRT aos resultados da análise de regressão de Moorfields (ARM), dos parâmetros morfométricos e da avaliação das fotografias estereoscópicas. Métodos: Uma coorte foi selecionada com 223 pacientes com suspeita de glaucoma, que foram seguidos por um período médio de 64,9 ± 37,3 meses. A suspeita de glaucoma baseou-se na aparência do disco óptico e/ou na pressão intraocular elevada (> 21 mmHg). Todos os participantes apresentavam dois exames de campo visual normais ao entrar no estudo. Conceituou-se progressão como o desenvolvimento de um defeito confirmado de campo visual ou deterioração do disco óptico na avaliação seriada das estereofotografias. A associação entre os resultados do HRT na época do início do acompanhamento e a progressão para glaucoma foi investigada através de modelos de regressão do tipo Cox. Usou-se o C-index para a comparação entre os modelos com os diversos parâmetros do HRT, isolados ou ajustados para os outros já conhecidos fatores de risco para progressão (idade, espessura corneana, pressão intraocular e pattern standard deviation PSD). Resultados: No período do estudo, 46 pacientes (21%) apresentaram progressão. Na análise multivariada, o GPS, a ARM e diversos parâmetros morfométricos foram preditivos para progressão, assim como a avaliação subjetiva das estereofotografias. Cada GPS 0,1 maior foi associado com um aumento de 23% no risco de progressão (C-index de 0,69). Os resultados anormais nas classificações finais do GPS e da ARM foram associados a aumentos de 3 e 2 vezes no risco de progressão, respectivamente (C-indexes de 0,70 e 0,68, respectivamente). O parâmetro com o melhor C-index foi a área seccional tranversa da camada de fibras nervosas (0,72). Uma área 0,3 mm2 menor foi associada a um risco 62% maior de progressão. A comparação do valor preditivo entre os modelos com o GPS e com a avaliação subjetiva das estereofotografias foi similar (C-indexes de 0,69 e 0,68, respectivamente). Conclusão: Nesse estudo observamos que as análises objetivas do disco óptico e da região peripapilar obtidas com o HRT contribuíram na avaliação do risco de progressão em pacientes com suspeita de glaucoma. O GPS mostrou-se tão eficaz quanto os parâmetros morfométricos e a análise de regressão de Moorfields, e a comparação do desempenho dos modelos contendo a avaliação subjetiva das estereofotografias e aqueles contendo a avaliação objetiva pelo GPS não mostrou diferenças significativas / Purpose: To evaluate the ability of baseline confocal scanning laser ophthalmoscopy, using the Heidelberg Retina Tomograph (HRT), in predicting the development of progression in patients suspected of having glaucoma. In addition, the study also aimed to compare the predictive abilities of the glaucoma probability score (GPS) with those of the Moorfields regression analysis (MRA) and stereometric parameters, and to compare the performance of the HRT with that of subjective evaluation of optic disc stereophotographs. Methods: This longitudinal study included a cohort of 223 eyes suspected of having glaucoma, which were followed for an average of 64.9 ± 37.3 months. Included suspects had a suspicious appearance of the optic disc and/or elevated intraocular pressure, but normal visual fields. Progression was defined as the development of either repeatable abnormal visual fields or glaucomatous structural deterioration in the appearance of the optic disc during the study period. The association between baseline HRT parameters and progression was investigated by Cox regression models. The comparison between models with HRT parameters, individually or combined with other known risk factors (age, central corneal thickness, pattern standard deviation and intraocular pressure), performed by comparing their C-indexes. Results: Forty-six (21%) eyes converted during the study period. In multivariable models, the GPS, the MRA, and the stereometric parameters were all predictive of progression. A GPS 0.1 larger was associated with an increase of 23% in the risk of progression (C-index of 0.69). Abnormal final classifications for the GPS or the MRA were associated with a three-fold and two-fold increase in the risk of progression, respectively (with C-indexes of 0.70 and 0.68, respectively). The parameter with the best C-index was the nerve fiber layer cross-sectional area (0.72). An area 0.3 mm2 smaller was associated with a 62% higher risk of an individual progress. The comparison between models with the HRT parameters and those with the subjective stereophotograph evaluation had similar results (C-indexes of 0.69 and 0.68, respectively). Conclusion: In this study, we were able to show that the objective structural assessment of the optic disc and peripapillary area obtained with the HRT was significantly predictive for progression in suspected individuals. The GPS was as predictive as the other HRT parameters, and no significant differences were observed between models with the GPS and those with the subjective assessment of the stereophotographs.

Objetivo: Estudar as medidas de espessura da camada de fibras nervosas da retina(CFNR) peripapilar obtidas com as tomografias de coerência óptia (oCT) time domain (TD) e spectral domain (SD) em pacientes com perda assimétrica glaucomatosa de hemicampo visual, compará-las entre si e com aquelas de controles normais. Métodos: Trinta e seis pacientes com glaucoma primário de ângulo aberto e perda de campo visual em um hemicampo (afetado) e ausência de perda no hemicampo oposto (não afetado), e 36 controles pareados por idade tiveram o olho de estudo examinado com Stratus-OCT (Carl Zeiss Meditec Inc., Dublin, Califoprnia, USA) e o 3DOCT-1000 (Topcdon, Tokyo, Japan). As medidas de espessura da CFNR peripapilar e a classificação normativa fornecida pelos aparelhos foram registrados para análise. A média aritmética dos valores do mapa total deviation em cada hemicampo (mean deviation do hemicampo) foi calculada para cada indivíduo. \"Ìndices de assimetria\" para o campo visual e para a CFNR foram calculados como a razão entre o mean deviation dos hemicampos afetado e não-afetado, e como razão entre a espessura da CFNR das hemirretinas afetada e não-afetada, respectivamente. As variáveis contínuas foram comparadas usando os testes de Mann-Whitney, Kruskal-Wallis ou Wilcoxon, quando apropriados. As variáveis categóricas foram comparadas usando o teste qui-quadrado de Pearson. O coeficiente de correlação de Spearman foi usado para testar as correlações entre as medidas de espessura da CFNR fornecidas pelos OCTs. A presença de afinamento da CFNR foi estabelecida com base nos dados normativos fornecidos pelos softwares dos OCTs. As espessuras de CFNR fora do intervalo de previsão de 95% para a mesma faixa etária foram consideradas anormais. Resultados: As medidas de CFNR corespondentes a hemicampos não-afetados [média (DP) 87,0 (17,1) um e 84,3 (20,2) um, para TD e SD-OCT, respectivamente] foram menores do que as dos controles [média (DP) 119,0 (122,2)um e 117,0 (17,7) um, para TD e SD-OCT, respectivamente, P < 0,001, para ambos]. O banco de dados normativo classificou como alterado 42% e 67% das hemirretinas correspondentes a hemicampos não-acometidos com TD e SD-OCT, respectivamente (P = 0,01). As medidas da CFNR foram consistentemente mais espessas com TD comparadas com SD-OCT. Os índices de assimetria da CFNR em pacientes com glaucoma foram semelhantes entre TD [média (DP) 0,76 (0,17)] e SD-OCT [média (DP) 0,79 (0,12), P = 0,89] e significantemente maiores do que o índice de assimetria do campo visual [média (DP) 0,36 (0,20), P < 0,001]. Conclusões: Os hemicampos normais de pacientes com glaucoma apresentaram CFNR mais fina do que de olhos saudáveis. As medidas da CFNR foram mais espessas com TD do que com SD-OCT, o qual por sua vez detectou anormalidades na espessura da CFNR mais frequentemente do que o TD-OCT / Objective: To study the peripapillary retinal nerve fiber layer (RNFL) thickness measurements obtained with time domain (TD) and spectral domain (SD) optical coherence tomography (OCT) in glaucomatous patients with asymmetric visual hemifield loss, to compare themselves and with those obtained from normal controls. Methods : Thirty -six patients with primary open-angle glaucoma with visual primary open-angle glaucoma with visual field loss in one hemifield (affected ) and absence of loss in other (non-affected), and 36 age-matched healthy controls had the eye study imaged with Stratus-OCT (Carl Zeiss Meditec Inc., Dublin, Califoprnia, USA) and 3D OCT-1000 (Topcon , Tokyo, Japan). Peripapillary RNFL thickness measurements and normative classification were recorded for analysis. Total deviation values were averaged for each hemifield (hemifield mean deviation) for ecch subject. Visual field and RNFL \"asymmetry indexes\" were calculated as the ratio between the mean deviation of affected versus non-affected hemifields and RNFL thickness between as affected versus non-affected hemiretinas, respectively. Continuous variables were compared using the Mann-Whitney, Kruskal-Wallis or Wilcoxon tests, when appropriate. Categorical variables were compared using the Pearson\'s chi-square test. The Spearman\'s rank correlation coefficient was used to test correlations between RNFL thickness measurements provided by both OCTs . The presence of RNFL thinning was establised based on normative data provided by the OCT\'s software. The RNFL thicknesses outside the prediction interval of 95% for the same age group were considered abnormal. Results: The RNFL measurements in non-affected hemifields [mean (SD 87.0 (17.1) e 84.3(20.2) um, for TD and SD-OCT, respectively] were thinner than those of normal controls [mean (SD) 119.0 (12.2) um and 117.0 (17.7) um, for TD and SD-OCT, respectively, P < 0.001 for both ] . The OCT normative database classified 42 % and 67% of hemiretinas corresponding to non-affected hemifields as abnormal in TD and SD-OCT, respectively (P =0.01). The RNFL measurements were consistently thicker with TD compared with SD -OCT. The RNFL thickness asymetry index in patients with glaucoma was similar with TD [ mean (SD) 0.76 ( 0.17 ) ] and SD-OCT [ mean (SD)0.79(0.12), P = 0,89] and significantly greater than the visual field asymmetry index [ mean (SD ) 0.36 (0.20 ), P < 0.001]. Conclusions: Normal hemifields of glaucoma patients had thinner RNFL measurements than healthy eyes, as measured by TD and SD-OCT. The RNFL measurements were thicker with TD than SD-OCT, SD-OCT detected abnormal RNFL more often than TD-OCT

Objetivo: Estudar as medidas de espessura da camada de fibras nervosas da retina(CFNR) peripapilar obtidas com as tomografias de coerência óptia (oCT) time domain (TD) e spectral domain (SD) em pacientes com perda assimétrica glaucomatosa de hemicampo visual, compará-las entre si e com aquelas de controles normais. Métodos: Trinta e seis pacientes com glaucoma primário de ângulo aberto e perda de campo visual em um hemicampo (afetado) e ausência de perda no hemicampo oposto (não afetado), e 36 controles pareados por idade tiveram o olho de estudo examinado com Stratus-OCT (Carl Zeiss Meditec Inc., Dublin, Califoprnia, USA) e o 3DOCT-1000 (Topcdon, Tokyo, Japan). As medidas de espessura da CFNR peripapilar e a classificação normativa fornecida pelos aparelhos foram registrados para análise. A média aritmética dos valores do mapa total deviation em cada hemicampo (mean deviation do hemicampo) foi calculada para cada indivíduo. \"Ìndices de assimetria\" para o campo visual e para a CFNR foram calculados como a razão entre o mean deviation dos hemicampos afetado e não-afetado, e como razão entre a espessura da CFNR das hemirretinas afetada e não-afetada, respectivamente. As variáveis contínuas foram comparadas usando os testes de Mann-Whitney, Kruskal-Wallis ou Wilcoxon, quando apropriados. As variáveis categóricas foram comparadas usando o teste qui-quadrado de Pearson. O coeficiente de correlação de Spearman foi usado para testar as correlações entre as medidas de espessura da CFNR fornecidas pelos OCTs. A presença de afinamento da CFNR foi estabelecida com base nos dados normativos fornecidos pelos softwares dos OCTs. As espessuras de CFNR fora do intervalo de previsão de 95% para a mesma faixa etária foram consideradas anormais. Resultados: As medidas de CFNR corespondentes a hemicampos não-afetados [média (DP) 87,0 (17,1) um e 84,3 (20,2) um, para TD e SD-OCT, respectivamente] foram menores do que as dos controles [média (DP) 119,0 (122,2)um e 117,0 (17,7) um, para TD e SD-OCT, respectivamente, P < 0,001, para ambos]. O banco de dados normativo classificou como alterado 42% e 67% das hemirretinas correspondentes a hemicampos não-acometidos com TD e SD-OCT, respectivamente (P = 0,01). As medidas da CFNR foram consistentemente mais espessas com TD comparadas com SD-OCT. Os índices de assimetria da CFNR em pacientes com glaucoma foram semelhantes entre TD [média (DP) 0,76 (0,17)] e SD-OCT [média (DP) 0,79 (0,12), P = 0,89] e significantemente maiores do que o índice de assimetria do campo visual [média (DP) 0,36 (0,20), P < 0,001]. Conclusões: Os hemicampos normais de pacientes com glaucoma apresentaram CFNR mais fina do que de olhos saudáveis. As medidas da CFNR foram mais espessas com TD do que com SD-OCT, o qual por sua vez detectou anormalidades na espessura da CFNR mais frequentemente do que o TD-OCT / Objective: To study the peripapillary retinal nerve fiber layer (RNFL) thickness measurements obtained with time domain (TD) and spectral domain (SD) optical coherence tomography (OCT) in glaucomatous patients with asymmetric visual hemifield loss, to compare themselves and with those obtained from normal controls. Methods : Thirty -six patients with primary open-angle glaucoma with visual primary open-angle glaucoma with visual field loss in one hemifield (affected ) and absence of loss in other (non-affected), and 36 age-matched healthy controls had the eye study imaged with Stratus-OCT (Carl Zeiss Meditec Inc., Dublin, Califoprnia, USA) and 3D OCT-1000 (Topcon , Tokyo, Japan). Peripapillary RNFL thickness measurements and normative classification were recorded for analysis. Total deviation values were averaged for each hemifield (hemifield mean deviation) for ecch subject. Visual field and RNFL \"asymmetry indexes\" were calculated as the ratio between the mean deviation of affected versus non-affected hemifields and RNFL thickness between as affected versus non-affected hemiretinas, respectively. Continuous variables were compared using the Mann-Whitney, Kruskal-Wallis or Wilcoxon tests, when appropriate. Categorical variables were compared using the Pearson\'s chi-square test. The Spearman\'s rank correlation coefficient was used to test correlations between RNFL thickness measurements provided by both OCTs . The presence of RNFL thinning was establised based on normative data provided by the OCT\'s software. The RNFL thicknesses outside the prediction interval of 95% for the same age group were considered abnormal. Results: The RNFL measurements in non-affected hemifields [mean (SD 87.0 (17.1) e 84.3(20.2) um, for TD and SD-OCT, respectively] were thinner than those of normal controls [mean (SD) 119.0 (12.2) um and 117.0 (17.7) um, for TD and SD-OCT, respectively, P < 0.001 for both ] . The OCT normative database classified 42 % and 67% of hemiretinas corresponding to non-affected hemifields as abnormal in TD and SD-OCT, respectively (P =0.01). The RNFL measurements were consistently thicker with TD compared with SD -OCT. The RNFL thickness asymetry index in patients with glaucoma was similar with TD [ mean (SD) 0.76 ( 0.17 ) ] and SD-OCT [ mean (SD)0.79(0.12), P = 0,89] and significantly greater than the visual field asymmetry index [ mean (SD ) 0.36 (0.20 ), P < 0.001]. Conclusions: Normal hemifields of glaucoma patients had thinner RNFL measurements than healthy eyes, as measured by TD and SD-OCT. The RNFL measurements were thicker with TD than SD-OCT, SD-OCT detected abnormal RNFL more often than TD-OCT