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Correlation Between The Ganglion Cell-Inner Plexiform
Correlation Between The Ganglion Cell-Inner Plexiform
PURPOSE. To evaluate relationships between the macular visual field (VF) mean sensitivity and
the ganglion cell and inner plexiform layer (GCA) thicknesses.
METHODS. Seventy-one glaucoma patients and 29 healthy subjects were included in this crosssectional study. At each visit, GCA thicknesses were measured by Cirrus HD-OCT and static
threshold perimetry was performed using Macular Integrity Assessment (MAIA). The
relationship between the VF sensitivity and GCA thickness was examined globally, and in
the superior hemiretina, inferior hemiretina, and six VF sectors with both VF and optical
coherence tomography (OCT) in retinal view. Regression analysis was used to investigate the
relationship between the GCA thickness and macular sensitivity.
RESULTS. Macular VF sensitivity (dB) and GCA thickness relationships were statistically
significant in each sector (R 0.3650.706, all P < 0.001). The highest correlation observed
was between the inferotemporal average mean sensitivity and the inferotemporal average
GCA thickness (R 0.706) with both VF and OCT in retinal view. Strength of the structure
function relationship for each of the corresponding inferior sectors was higher than those for
the corresponding superior sectors. The strength of the structurefunction relationship of the
temporal sector was higher than that of the nasal sector.
CONCLUSIONS. GCA thickness measured by Cirrus HD-OCT showed statistically significant
structurefunction associations with central VF. Inferotemporal central VF had the strongest
association.
Keywords: optical coherence tomography, visual field, microperimetry
Copyright 2013 The Association for Research in Vision and Ophthalmology, Inc.
www.iovs.org j ISSN: 1552-5783
3046
MATERIALS
AND
METHODS
Microperimetry Examinations
In all subjects, MAIA was used to measure the retinal
sensitivity. MAIA was performed in a dim room without any
dilation of the pupil. The following parameters were used in
the current study: a 68-stimuli grid covering the central 108 of
the retina, a 4 to 2 threshold strategy, a fixation target that
consisted of a red circle with a 18 diameter, stimulus size
Goldmann III, background luminance set at 4 apostilb (asb),
maximum luminance of 1000 asb, and a stimulus dynamic
range of 36 dB. Use of the MAIA device made it possible to
determine which of the fixation stabilities were stable. Only
stable fixation tests were included in the analysis.
Statistical Analysis
To determine the association between the local VF mean
sensitivity and the relative GCA thickness, we based this study
on previous work that related the SAP sensitivity to peripapillary RNFL thickness1517 or RGC IPL thickness (GCA) in the
macula.8 Briefly, the assumptions for this model were as
follows: the measured GCA thickness R consists of two
components, the thickness S, which is due to portions of the
IPL and RGC layer (GCA) that is affected by glaucoma, and the
residual B, which includes portions of the IPL and RGC layer
FIGURE 1. Detection of macular sensitivity. Right eye fundus image of a 50-year-old patient with primary open-angle glaucoma (POAG). Figure
shows microperimetry results with differential light threshold values color-coded from 0 to 36 dB.
FIGURE 2. Representative example showing the six sectors of the ganglion cell analyzer thickness and the adjustment for retinal ganglion cell
displacement. (A) The 10 to 2 VF displaced points corresponding to the RGC locations based on a model derived from histologic analysis.5 (B) GCA
thickness areas were divided into six sectors, with the corresponding VF regions then obtained using MAIA.
Glaucoma
Normal
Age, y
Sex (M/F)
Diagnosis
62.5 6 11.0
40/31
64.3 6 12.2
17/12
0.71
0.83
POAG
NTG
EG
32
37
2
Mean Sensitivity, dB
Refraction (D)
1.6 6 2.3
0.7 6 1.9
0.10
RESULTS
A total of 71 glaucoma patients (32 POAG, 37 normal-tension,
and 2 exfoliative) and 29 healthy subjects were enrolled in the
study. The demographic characteristics are presented in Table
1. Since the healthy control participants were selected based
on age- and refractive error-matching, there was no significant
difference noted in the mean age between the healthy subjects
and glaucoma patients. Based on the standard VF severity
grading scale,18 the grade of the disease in the glaucomatous
eyes of the 71 patients ranged from early to moderate, with 29
(41%) classified as early, 24 (34%) classified as moderate, and
18 (25%) classified as severe.
Table 2 lists the GCA thickness, while Table 3 presents the
macular sensitivity. GCA thickness and macular sensitivity were
significantly different between the glaucoma and healthy
subject groups.
Figure 3 shows the structurefunction relationship between the GCA thickness and the corresponding VF mean
sensitivity with both OCT and VF in retinal view. To check the
goodness of fit, we calculated the number of points falling
outside the 95% confidence boundary. For the global GCA
thicknessVF mean sensitivity, seven eyes fell outside of the
95% confidence boundary. Although the difference in the
structurefunction relationship was not significant among six
sectors, the highest Spearman correlation coefficient was
0.706 in the inferotemporal sector. Strength of the structure
function relationship of each of the corresponding inferior
sectors (R 0.5460.706) were higher than those of the
65.1
67.1
63.1
63.9
67.5
70.9
59.6
62.0
67.7
6
6
6
6
6
6
6
6
6
7.7
9.2
8.0
9.8
9.6
10.0
9.0
8.4
9.2
Normal
6
6
6
6
6
6
6
6
6
<0.01
<0.01
<0.01
<0.01
<0.01
<0.01
<0.01
<0.01
<0.01
79.8
80.8
78.8
79.6
81.0
81.7
80.4
76.6
79.4
5.2
5.5
5.5
5.1
6.5
6.3
6.1
5.9
5.7
Glaucoma
Average
Superior hemifield
Inferior hemifield
Superotemporal
Superior
Superonasal
Inferotemporal
Inferior
Inferonasal
21.4
23.4
19.4
21.4
23.6
25.1
17.5
16.8
24.2
6
6
6
6
6
6
6
6
6
6.3
6.0
8.4
8.3
6.8
5.6
10.3
11.1
6.5
Normal
6
6
6
6
6
6
6
6
6
<0.01
<0.01
<0.01
<0.01
0.02
0.07
<0.01
<0.01
0.02
26.9
26.9
26.9
26.9
26.8
27.1
27.0
26.4
27.1
1.5
1.6
1.5
1.7
2.0
1.7
1.7
1.6
1.8
DISCUSSION
The pathology of glaucoma is characterized by the death of
RGCs and their axons. Although there is substantial individual
variability, the average retina contains 1.07 million RGCs, with
approximately 50% of the RGCs located within 4.5 mm of the
fovea.19,20 It has been demonstrated in humans that the RGC
loss is evident around the fovea during the early stages of the
disease.21 Therefore, we selected the central macular VF as the
local functional target in the current study and then assessed its
structurefunction relationship by using the GCA thickness.
Although SAP is able to show the functioning of individual
retinal locations in the macula, reliable test results can be
difficult to obtain because of unstable fixation in some cases.
When using an autotracking system, MAIA is able to
automatically record the fixation behavior during the test
while the autotracking system makes it possible to adjust the
stimulus points to predefined retinal positions and perform
reliable field testing, even in eyes with unstable fixation.
Because of these advantages, this study used MAIA to measure
the macular VF sensitivity.
The current study examined structurefunction relationships in smaller regions, which to the best of our knowledge,
has not been previously investigated. The determination of
which region has a stronger structurefunction association has
clinical implications, as use of the stronger region could
provide better detection and follow up in glaucoma patients
who may present with an early stage of macular VF defects.
Thus, our current results indicate the importance of studying
the relationship patterns in smaller regions. The strength of the
structurefunction relationship is related to the individual
anatomy and its variation in the subject, the stage of glaucoma
present in the study sample, the VF scale, and the regression
model used. During the previous examinations of the
correlations between the VF sensitivity and the early glaucomatous stages, healthy individuals, and the glaucoma suspect
eyes, the correlations were shown to be weaker than those
observed in moderate-to-severe glaucoma.22,23 The reason for
this is because the range of VF is narrow in healthy and
glaucoma suspect eyes. Thus, the strength of a structure
function relationship may be dependent upon both the actual
retinal and VF areas in which the association is assessed and
FIGURE 3. Scatters plots showing the association between the Cirrus HD-OCT thickness parameters and the corresponding retinal sensitivity. (A)
Average thickness of the GCA versus the macular mean sensitivity. (B) Superior average thickness of the GCA versus the superior macular mean
sensitivity. (C) Inferior average thickness of the GCA versus the inferior macular mean sensitivity. (D) Superotemporal thickness of the GCA versus
the superotemporal mean sensitivity. (E) Superior thickness of the GCA versus the superior mean sensitivity. (F) Superonasal thickness of the GCA
versus the superonasal mean sensitivity. (G) Inferotemporal thickness of the GCA versus the inferotemporal mean sensitivity. (H) Inferior thickness
of the GCA versus the inferior mean sensitivity. (I) Inferonasal thickness of the GCA versus the inferonasal mean sensitivity. Spearman correlation
coefficients, *P < 0.001.
Acknowledgments
Disclosure: S. Sato, None; K. Hirooka, None; T. Baba, None; K.
Tenkumo, None; E. Nitta, None; F. Shiraga, None
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