Clinically Detectable Nerve Fiber Atrophy Precedes the Onset of Glaucomatous Field Loss

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Abstract

Standardized perimetry and nerve fiber layer and color fundus photography were performed annually on 1344 eyes with elevated intraocular pressures. In 83 eyes, glaucomatous field defects developed that met rigid criteria on manual kinetic and suprathreshold static perimetry. Individual nerve fiber layer photographs were read by two masked observers. The more sensitive of the two identified nerve fiber layer defects in 88% of readable photographs at the time field loss first occurred; 60% (6/10) of eyes already had nerve fiber layer defects 6 years before field loss. In contrast, the nerve fiber layer was considered abnormal in only 11% (3/27) of normal eyes and 26% (84/327) of hypertensive eyes. The location of nerve fiber layer and field defects closely corresponded, but nerve fiber layer loss was generally more widespread. Examiner experience and severity of optic nerve damage influenced results. Mild focal defects were more readily recognized than more severe diffuse atrophy. Nerve fiber layer defects expanded with time, often by the development and coalescence of adjacent areas of damage.

Original languageEnglish (US)
Pages (from-to)77-83
Number of pages7
JournalArchives of Ophthalmology
Volume109
Issue number1
DOIs
StatePublished - 1991

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Nerve Fibers
Atrophy
Visual Field Tests
Photography
Optic Nerve
Intraocular Pressure
Color

ASJC Scopus subject areas

  • Ophthalmology

Cite this

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title = "Clinically Detectable Nerve Fiber Atrophy Precedes the Onset of Glaucomatous Field Loss",
abstract = "Standardized perimetry and nerve fiber layer and color fundus photography were performed annually on 1344 eyes with elevated intraocular pressures. In 83 eyes, glaucomatous field defects developed that met rigid criteria on manual kinetic and suprathreshold static perimetry. Individual nerve fiber layer photographs were read by two masked observers. The more sensitive of the two identified nerve fiber layer defects in 88{\%} of readable photographs at the time field loss first occurred; 60{\%} (6/10) of eyes already had nerve fiber layer defects 6 years before field loss. In contrast, the nerve fiber layer was considered abnormal in only 11{\%} (3/27) of normal eyes and 26{\%} (84/327) of hypertensive eyes. The location of nerve fiber layer and field defects closely corresponded, but nerve fiber layer loss was generally more widespread. Examiner experience and severity of optic nerve damage influenced results. Mild focal defects were more readily recognized than more severe diffuse atrophy. Nerve fiber layer defects expanded with time, often by the development and coalescence of adjacent areas of damage.",
author = "Alfred Sommer and Joanne Katz and Quigley, {Harry A} and Miller, {Neil R} and Robin, {Alan L.} and Richter, {Ronald C} and Witt, {Kathe A.}",
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T1 - Clinically Detectable Nerve Fiber Atrophy Precedes the Onset of Glaucomatous Field Loss

AU - Sommer, Alfred

AU - Katz, Joanne

AU - Quigley, Harry A

AU - Miller, Neil R

AU - Robin, Alan L.

AU - Richter, Ronald C

AU - Witt, Kathe A.

PY - 1991

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AB - Standardized perimetry and nerve fiber layer and color fundus photography were performed annually on 1344 eyes with elevated intraocular pressures. In 83 eyes, glaucomatous field defects developed that met rigid criteria on manual kinetic and suprathreshold static perimetry. Individual nerve fiber layer photographs were read by two masked observers. The more sensitive of the two identified nerve fiber layer defects in 88% of readable photographs at the time field loss first occurred; 60% (6/10) of eyes already had nerve fiber layer defects 6 years before field loss. In contrast, the nerve fiber layer was considered abnormal in only 11% (3/27) of normal eyes and 26% (84/327) of hypertensive eyes. The location of nerve fiber layer and field defects closely corresponded, but nerve fiber layer loss was generally more widespread. Examiner experience and severity of optic nerve damage influenced results. Mild focal defects were more readily recognized than more severe diffuse atrophy. Nerve fiber layer defects expanded with time, often by the development and coalescence of adjacent areas of damage.

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