Blue-on-yellow visual field and retinal nerve fiber layer in ocular hypertension and glaucoma1☆
Received 28 August 1997; accepted 2 June 1998.
Abstract
Background and objective
It has been suggested that the clinically detectable changes of the blue-on-yellow (B/Y) visual field and retinal nerve fiber layer (RNFL) may precede standard white-on-white (W/W) visual field defects in the progression of glaucoma. The aim of this study was to test the relationship between the results of B/Y visual fields and semiquantitative RNFL evaluation in corresponding areas and to determine how the B/Y visual fields and RNFL scores label the normal W/W perimetry hemifields in patients with glaucoma and ocular hypertension.
Design
A cohort study.
Participants and methods
Monochromatic RNFL photographs of 32 normal subjects and 29 patients with ocular hypertension and different stages of glaucoma were assessed in a masked fashion. The B/Y and W/W visual fields (program 30–2) were examined with a Humphrey perimeter. The results of both visual fields were adjusted for the patients’ age and lens transmission index measured with a lens fluorometer.
Main outcome measure
Mean deviation (MD) of visual field and semiquantitative score of RNFL loss were measured.
Results
The total and hemifield MD values of B/Y and W/W visual field showed a statistically significant correlation with diffuse and overall score of RNFL loss in corresponding areas. The hemifield MD values of B/Y perimetry obtained from “normal” W/W hemifields of patients with early glaucoma were well correlated (r = −0.56) with respective RNFL loss scores found to be abnormal in 84% of hemispheres. The difference between the hemifield MD values of B/Y perimetry obtained from normal W/W hemifields of patients with ocular hypertension and patients with early glaucoma was not statistically significant (analysis of variance). The respective B/Y hemifield data of normal subjects were statistically significantly different from the data of patients with ocular hypertension and early glaucoma.
Conclusions
The hemifield MD values of B/Y perimetry correlate well with semiquantitative scores of RNFL loss obtained from the corresponding hemisphere. The B/Y perimetry as well as RNFL assessment may show glaucomatous defects in a hemifield found to be normal on W/W perimetry. In subjects with ocular hypertension, the functional damage detected by B/Y perimetry may, in some cases, precede RNFL defects on conversion to glaucoma.
Manuscript no. 97494.
aDepartment of Ophthalmology, University of Oulu, Oulu, Finland
Reprint requests to Pait Teesalu, MD, Department of Ophthalmology, University of Tartu, Kupejanovi 1, EE 2400 Tartu, Estonia
Address correspondence to P. Juhani Airaksinen, MD, Department of Ophthalmology, University of Oulu, SF-90220 Oulu 22, Finland
☆ Supported by a grant from the Silmä-ja Kudospankki Foundation and a scholarship of the Nordic Council of Ministers.
1 The authors have no proprietary interest in any of the materials used in this study.
ABSTRACT