[Local and diffuse changes in the nerve fiber layer in glaucoma and vascular involvement of the optic papilla....

Alterations in the retinal nerve-fiber layer, as seen in red-free illumination, are early signs of glaucomatous damage. First, small localized defects are often overseen in routine static automated perimetry, as the earliest psychophysical correlation is only a slight, localized increase in short-term fluctuation. Larger, absolute nerve-fiber-bundle defects of glaucomatous or vascular origin lead to broad, arcuate visual field defects, known as Bjerrum scotomata. Diffuse atrophy of the retinal nerve-fiber layer can also be seen in glaucomatous eyes, but it is difficult to detect and can therefore easily be missed by the observer. Perimetric correlations in these cases are mostly identical Bjerrum scotomata, as seen in localized nerve-fiber bundle defects. However, it seems possible that a diffuse reduction in sensitivity can only be detected. If stable fixation is attained, a good, but nevertheless indirect correspondence between the visual field defect and nerve-fiber bundle defect can be obtained by simply superimposing the fundus image on the perimetric results. Fundus-controlled perimetry is a direct combination of these two investigative methods. The advantage of fundus-controlled permetry is a precise, point-to-point correspondence between the fundus image and perimetric results, which is impossible to achieve by projection perimetry. The scanning laser ophthalmoscope is the most suitable device for simultaneously imaging the fundus and conducting psychophysical testing. For static fundus-controlled perimetry we adapted the confocal scanning laser ophthalmoscope from Rodenstock by adding an infrared laser for fundus imaging. The HeNe laser is still used for background illumination, generation of stimuli, and fixation by computer-controlled acousto-optic modulation.(ABSTRACT TRUNCATED AT 250 WORDS)