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Br J Ophthalmol 1999;83:290-294 ( March )

Detection of optic disc change with the Heidelberg retina tomograph before confirmed visual field change in ocular hypertensives converting to early glaucoma

D S Kamal,a A C Viswanathan,b D F Garway-Heath,a R A Hitchings,a D Poinoosawmy,a C Buncec

a Glaucoma Unit, Moorfields Eye Hospital London, b Department of Visual Science, Institute of Ophthalmology, London, c Glaxo Department of Epidemiology, Moorfields Eye Hospital, London

Correspondence to: Mr R A Hitchings, Glaucoma Unit, Moorfields Eye Hospital, City Road, London EC1V 2PD.

Accepted for publication 30 September 1998

AIM---To determine whether analysis of sequential optic disc images obtained with the Heidelberg retina tomograph (HRT) is able to demonstrate optic disc change before the development of reproducible field defects in a group of ocular hypertensive (OHT) patients converting to early glaucoma.
METHODS---Two groups were analysed: (1) 13 eyes of 13 OHT patients who subsequently developed reproducible field defects (converters); and (2) 13 eyes of 11 normal control subjects. Two sequential optic disc images were obtained using the HRT (median separation between images was 12 months for the converters and 13 months for the normals). The second image in the converter group was obtained before confirmed visual field loss. The optic disc variables were analysed both globally and segmentally using HRT software version 1.11. The Wilcoxon signed rank test was used to determine if there were any significant differences between the variables of the two image sets.
RESULTS---Significant optic disc change was demonstrated in the group of converters: (1) global variables: the cup area increased by 9.7%, the C/D area ratio increased by 10.5%, and the rim area decreased by 6.9%; (2) segmental variables: the superonasal cup area increased by 11.0%, the superonasal C/D area ratio increased 11.7%, and the inferonasal cup volume increased by 28.4%.The temporal rim volume decreased by 15.6%, the inferotemporal rim volume decreased by 23.6%, and the rim area in the superonasal and superotemporal segments decreased by 6.6% and 6.9% respectively.
CONCLUSION---Analysis of sequential optic disc images on the HRT allowed the detection of glaucomatous change before confirmed visual field change in a group of OHT patients converting to early glaucoma.

Keywords: optic disc; Heidelberg retina tomograph; visual field; ocular hypertension; glaucoma

© 1999 by British Journal of Ophthalmology


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