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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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Assessing Early Stage Open-Angle Glaucoma in Patients by Isolated-Check Visual Evoked Potential
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Optic nerve head factors associated with initial central visual field defect in primary open-angle glaucoma.

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Initial parafoveal scotoma in primary open-angle glaucoma is linked to optic nerve head factors. Closer retinal nerve fiber layer defects to the fovea and oblique lamina cribrosa/Bruch

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Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Optic Nerve Head Imaging

Background:

  • Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
  • Initial parafoveal scotoma (IPFS) is an early visual field defect in POAG.
  • Understanding the structural correlates of IPFS is crucial for early diagnosis and management.

Purpose of the Study:

  • To investigate optic nerve head (ONH) factors associated with initial parafoveal scotoma (IPFS) compared to initial nasal step (INS) defects in primary open-angle glaucoma (POAG).

Main Methods:

  • Retrospective analysis of 80 POAG patients with IPFS and 84 with INS.
  • Quantitative assessment of central retinal vascular trunk (CRVT) deviation from the Bruch's membrane opening (BMO) center (lamina cribrosa/BMO offset obliqueness).
  • Evaluation of retinal nerve fiber layer defect (RNFLD) proximity to the fovea and microvasculature dropout (MvD) using logistic regression and conditional inference tree analysis.

Main Results:

  • The IPFS group exhibited significantly more oblique CRVT offset, RNFLD closer to the fovea, and increased MvD compared to the INS group (P < 0.001 for all).
  • Logistic regression identified oblique CRVT offset (P=0.002), RNFLD proximity (P < 0.001), and MvD (P=0.001) as significant predictors of IPFS.
  • Conditional inference tree analysis highlighted RNFLD proximity as the primary factor, followed by CRVT offset obliqueness and MvD.

Conclusions:

  • IPFS in POAG is strongly associated with RNFLD located closer to the fovea, as measured from the BMO.
  • Oblique lamina cribrosa/BMO offset may contribute to IPFS by masking RNFLD proximity and potentiating focal defects and microvasculature dropout.
  • These findings emphasize the role of ONH structural anomalies in the pathogenesis of early glaucomatous visual field loss.