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. 2000 Sep;84(9):1008–1012. doi: 10.1136/bjo.84.9.1008

Altitudinal visual field asymmetry is coupled with altered retinal circulation in patients with normal pressure glaucoma

O Arend 1, A Remky 1, L Cantor 1, A Harris 1
PMCID: PMC1723619  PMID: 10966955

Abstract

AIM—To compare the effect of altitudinal asymmetric glaucomatous damage on retinal microcirculation in patients with normal pressure glaucoma (NPG).
METHODS—In a prospective cross sectional study patients with NPG (washed out for antiglaucomatous therapy) and altitudinal asymmetric perimetric findings between the superior and inferior hemisphere (Humphrey 24-2) (n=18) were included and compared with 20 NPG patients with symmetrical field defects and 18 healthy subjects. Fluorescein angiograms were performed using a scanning laser ophthalmoscope. Using digital image analysis, arteriovenous passage time (AVP) and vessel diameters were assessed for comparison of corresponding affected and less affected temporal arcades.
RESULTS—Both affected and less affected hemispheres showed significantly prolonged AVP times (p<0.001) when compared with healthy subject data. In hemispheres with more severe glaucomatous field loss the AVP times were significantly (p=0.04) prolonged compared with the less affected hemisphere (AVP affected 3.1 (SD 7) seconds v AVP less affected 2.61 (1.4) seconds). There was no asymmetry effect on arterial and venous diameter measurements.
CONCLUSION—Altitudinal visual field defects are linked together with circulatory deficits of the retinal tissue. The attenuated circulation seems to be a considerable factor in the natural course of glaucomatous optic neuropathy.



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Figure 1  .

Figure 1  

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(A) Asymmetric visual field loss of the inferior visual field (Humphrey 24-2) with an arcuate scotoma in the inferior hemifield. (B) Corresponding fluorescein angiogram with focal ischaemia of the optic disc temporally superior (AVP time of the affected temporal superior vessel: 2.17 seconds ; the less affected temporal inferior vessel formation: 1.67 seconds).

Figure 2  .

Figure 2  

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(A) Asymmetric hemifield visual field loss of the superior visual field (Humphrey 24-2). (B) Corresponding fluorescein angiogram with ischaemia of the inferior portion of the optic disc (AVP of affected inferior vessel formation: 3.6 seconds; AVP of less affected superior vessel formation: 2.23 seconds). Note the visible different fluorescein intensity of the laminar stream of the dye in the veins superiorly and inferiorly.

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