High-Pass Visual Acuity Loss and Macular Structure-Function Relationship in Patients With Primary Open-Angle Glaucoma

Area of Science:

• Ophthalmology
• Optometry
• Medical Imaging

Background:

• Logarithm of the Minimum Angle of Resolution (logMAR) charts are standard for glaucoma visual function assessment.
• Conventional visual acuity (VA) may not detect severe macular damage in glaucoma patients.
• High-pass VA offers a potential alternative for enhanced glaucoma detection.

Purpose of the Study:

• To investigate the advantages of high-pass VA in detecting glaucoma compared to conventional VA.
• To compare the performance of a novel high-pass electronic VA chart with a conventional e-chart.
• To explore structure-function relationships between macular GCL+IPL thickness and VA measurements in glaucoma.

Main Methods:

• Compared monocular best-corrected VA using high-pass and conventional e-charts in 113 primary open-angle glaucoma (POAG) patients and 65 controls.
• Utilized spectral-domain optical coherence tomography (SD-OCT) to measure macular ganglion cell layer plus inner plexiform layer (GCL+IPL) thickness in 139 POAG patients.
• Analyzed structure-function relationships, correlating VA with GCL+IPL thickness, and categorized patients based on macular visual field (MVF) defects.

Main Results:

• High-pass e-chart demonstrated a significantly larger area under the receiver operating characteristic curve (0.917) than the conventional e-chart (0.757).
• Significant correlations between high-pass VA and GCL+IPL thickness were observed, particularly in the MVF-damaged group.
• High-pass VA showed stronger correlations with nasal-side macular GCL+IPL thickness compared to conventional VA.

Conclusions:

• High-pass VA exhibits increased sensitivity to visual loss in glaucoma patients.
• High-pass VA demonstrates a stronger correlation with macular GCL+IPL thickness, indicating better structure-function linkage.
• The high-pass acuity test shows promise as an ancillary tool for glaucoma monitoring.