Systemic Vascular Risk Factors for Multiple Retinal Nerve Fiber Layer Defects

Area of Science:

• Ophthalmology
• Glaucoma Research
• Neuroscience

Background:

• Glaucomatous retinal nerve fiber layer (RNFL) loss typically presents as a single defect per quadrant.
• Multiple, isolated RNFL defects are uncommon but may indicate distinct pathophysiological processes.

Purpose of the Study:

• To identify risk factors associated with multiple RNFL defects.
• To understand the clinical relevance and pathogenesis of varied RNFL defect patterns in glaucoma.

Main Methods:

• Retrospective analysis of glaucoma patients with multiple RNFL defects (n=28) versus those without (n=194).
• Propensity score matching was used to control for age and mean deviation.
• Definition of multiple RNFL defects: three or more isolated defects separated by normal areas.

Main Results:

• Patients with multiple RNFL defects exhibited a higher prevalence of hypertension, end-stage renal disease, and cerebrovascular disease.
• These associations remained significant after propensity score matching.
• A greater number of patients with multiple RNFL defects had parafoveal visual field points depressed <5%.

Conclusions:

• Multiple RNFL defects are clinically relevant and associated with systemic vascular risk factors.
• The presence of multiple RNFL defects may indicate an increased risk of parafoveal scotoma.
• Clinicians should consider potential coexisting systemic vascular diseases in patients presenting with multiple RNFL defects.