Br J Ophthalmol 2000;84:993-998
( September )
Use of sequential Heidelberg retina tomograph images to identify
changes at the optic disc in ocular hypertensive patients at risk of
developing glaucoma
D S Kamala, D F Garway-Heatha, R A Hitchingsa, F W Fitzkeb
a Glaucoma Unit,
Moorfields Eye Hospital, London EC1V 2PD, b Institute of Ophthalmology, London
Correspondence to: Professor R A Hitchings roger.hitchings{at}virgin.net
Accepted for publication 26 April 2000
AIM To determine if
global and segmental changes in optic disc parameters of sequential
Heidelberg retina tomograph (HRT) images develop in individual ocular
hypertensive (OHT) patients without white on white visual field defects.
METHODSPatients and
normal controls were recruited from a prospective ocular hypertension
treatment trial. The subject groups consisted of 21 OHT patients who
had converted to early glaucoma on the basis of visual field criteria
(24-2 program on the Humphrey perimeter), 164 OHT subjects with normal
visual fields, and 21 normal controls. Sequential HRT images 16-21
months apart were obtained for each subject and segmental optic disc
parameters were measured to determine if any change had occurred. From
the analysis of sequential HRT images of the 21 normal eyes we
established normal limits of interimage variation. Individual discs in
each group showing changes above the 95% limit of normal variability
were then sought.
RESULTSSeveral
segmental and global optic disc parameters were found to show
significant change in the converter group before confirmed visual field
change, confirming our previously published results. Individual optic
disc analysis using the 95% limit of normal variability data
demonstrated glaucomatous change in 13 out of 21 converter eyes. 47 of
the 164 OHT eyes with normal visual fields showed change in global and
segmental parameters in a "glaucomatous" direction above the level
expected for normal variability. The parameters which changed most
frequently in the OHT eyes were: global cup volume (6.7% of discs),
inferonasal cup volume (11%), inferotemporal cup volume (8.5%), and
superotemporal cup area (7.3%).
CONCLUSIONSWe have
identified change in a subset of ocular hypertensive patients which
could predate the development of glaucomatous visual field loss. The
HRT could be of value in the sequential follow up of those suspected of
having glaucoma by identifying eyes at risk of developing glaucoma.
However, further refinement of the technique is required to eliminate
some of the inherent variability of the analysis method described, and
to increase the ability to detect at risk individuals.
© 2000 by British Journal of Ophthalmology
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