The relationship between oxygenation of residual neuroretinal rim tissue and visual field sensitivity in glaucoma

J.
1Faculty

1, Denniss

I.

1, Schiessl
2

1, V.Nourrit

C.H.

1,2, Fenerty
3

D.B.

3 Henson

of Life Sciences, University of Manchester,

Manchester Royal Eye Hospital, School of Biomedicine, University of Manchester, UK

Purpose
To demonstrate a relationship between oxygenation of residual neuroretinal rim (NRR) and visual field (VF) sensitivity in patients with glaucoma.
Figure 1: Example oxygenation map of an optic disc (left) and corresponding visual field (right). In the oxygenation map brighter areas represent areas of greater oxygenation. The arrow in the oxygenation map points to a darker area corresponding to the visual field defect.

Results
Significant relationships were found between superiorinferior hemifield difference in VF sensitivity and superior-inferior difference in NRR oxygenation (r=0.61, p<0.001). Significant relationships were also found between difference in sensitivity between corresponding VF areas and: (1) superior-/inferiortemporal NRR oxygenation difference (r=0.61, p<0.001) and (2) superior-/inferior-nasal NRR oxygenation difference (r=0.63, p<0.001). These relationships were not significantly altered when taking into account NRR area in a multiple regression analysis.

Methods
Multispectral optic disc images captured with a modified fundus camera (8 wavelengths, range 490-700nm, acquisition time ~1.6s), HRT3 (Heidelberg Retina Tomograph) optic disc topographies and visual fields were taken from 33 eyes of 18 patients with primary open-angle glaucoma. A Beer-Lambert law calculation was used to calculate optic disc oxygenation maps from the aligned multispectral images, and the residual NRR was isolated from these as defined by HRT3 topography. Differences in NRR oxygenation between both superior/inferior portions and vertically opposing 45 sectors were compared with differences in sensitivity between corresponding VF areas. The effect of combining NRR oxygenation and area data on the relationship with VF sensitivity was also measured.
Figure 2: Diagram of optic disc (right) and anatomically related visual field sectors (left) for a right eye, adapted from Garway-Heath et al (IOVS 2002). The dashed lines indicate sectors from the published map which were divided into two to create our eight equal sectors. Sectors are labelled as in figure 4.

Figure 3: Inferior-superior differences in NRR oxygenation (left) and NRR area (right) vs. differences in sensitivity of corresponding visual field areas. The plots include Pearson correlation coefficients and associated p-values as well as a diagrammatic representation of the optic disc sectors considered. The right-hand plot is provided as an example comparison between our technique and a currently available instrument.

Figure 5: Example of an oxygenation map (a), aligned HRT3 topography image (b), and masked oxygenation map leaving only NRR tissue (c). In the HRT3 topography image the NRR was represented by the light grey and black areas combined and it was on this area that the mask used to create (c) was based.

Conclusions
Superior-inferior differences in oxygenation of residual NRR are strongly related to superior-inferior differences in VF sensitivity in patients with glaucoma. This relationship is independent of NRR area. Multispectral imaging shows considerable promise as a clinical tool to provide important information on optic disc perfusion..

Figure 4: Differences in NRR oxygenation (arbitrary units) between vertically opposing optic disc sectors vs. differences between sensitivity of corresponding visual field areas. The plots include Pearson correlation coefficients and associated p-values as well as a diagrammatic representation of the optic disc sectors considered (for a right eye). Sectors are labelled as in figure 2.

Current/Future Work
Use of multispectral imaging in predicting treatment efficacy and future structural/functional loss.

j.denniss@postgrad.manchester.ac.uk Support: College of Optometrists (UK) PhD Studentship (JD), Manchester Academic Health Sciences Centre (MAHSC) and the NIHR Manchester Biomedical Research Centre.