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Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...
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In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
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Effect of fundus tracking on structure-function relationship in glaucoma.

Giovanni Montesano1,2, Luca M Rossetti3, Allison M McKendrick4

  • 1Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK.

The British Journal of Ophthalmology
|March 4, 2020
PubMed
Summary

Fundus tracking perimetry shows similar structure-function relationships to standard methods in glaucoma. However, it may enhance diagnostic ability when combined with a Structure Function Index, particularly in eyes with existing perimetric damage.

Keywords:
diagnostic tests/investigationglaucomaimagingpsychophysics

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Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Glaucoma Research

Background:

  • Glaucoma diagnosis and monitoring rely on assessing the relationship between visual field function and retinal nerve fiber layer structure.
  • Standard perimetry methods may have limitations in accurately capturing this structure-function relationship.

Purpose of the Study:

  • To investigate the impact of fundus tracking perimetry on the structure-function relationship in glaucoma patients.
  • To compare the diagnostic performance of a combined Structure Function Index (SFI) using fundus tracking versus standard perimetry.

Main Methods:

  • Retrospective analysis of perimetric data from Humphrey Field Analyzer (HFA) and Compass fundus perimeter (CMP) with fundus tracking.
  • Inclusion of circumpapillary retinal nerve fibre layer (Cp-RNFL) thickness data from optical coherence tomography.
  • Exploration of structure-function relationships using global indices and visual field clusters, with R-squared values from mixed-effect models.
  • Assessment of diagnostic ability using partial receiver operating characteristic curves and areas under the curve.

Main Results:

  • Global structure-function relationship R-squared values were comparable between CMP (0.50) and HFA (0.48).
  • Including visual field clusters yielded similar R-squared values for CMP (0.29) and HFA (0.30).
  • The combined SFI showed no significant improvement over Cp-RNFL alone for either perimeter, but performed significantly better in eyes with perimetric damage, with CMP-SFI outperforming HFA-SFI.

Conclusions:

  • The structure-function relationship in glaucoma appears similar between fundus tracking and standard perimetry.
  • Fundus tracking, when integrated into a combined SFI, holds potential for improved diagnostic discrimination, especially in compromised visual fields.