NYMC Faculty Publications
Glaucomatous Damage of the Macula
Author Type(s)
Faculty
DOI
10.1016/j.preteyeres.2012.08.003
Journal Title
Progress in Retinal and Eye Research
First Page
1
Last Page
21
Document Type
Article
Publication Date
1-1-2013
Department
Ophthalmology
Keywords
Glaucoma, Humans, Intraocular Pressure, Macula Lutea, Nerve Fibers, Retinal Diseases, Retinal Ganglion Cells, Tomography, Optical Coherence, Visual Field Tests, Visual Fields
Disciplines
Medicine and Health Sciences | Ophthalmology
Abstract
There is a growing body of evidence that early glaucomatous damage involves the macula. The anatomical basis of this damage can be studied using frequency domain optical coherence tomography (fdOCT), by which the local thickness of the retinal nerve fiber layer (RNFL) and local retinal ganglion cell plus inner plexiform (RGC+) layer can be measured. Based upon averaged fdOCT results from healthy controls and patients, we show that: 1. For healthy controls, the average RGC+ layer thickness closely matches human histological data; 2. For glaucoma patients and suspects, the average RGC+ layer shows greater glaucomatous thinning in the inferior retina (superior visual field (VF)); and 3. The central test points of the 6° VF grid (24-2 test pattern) miss the region of greatest RGC+ thinning. Based upon fdOCT results from individual patients, we have learned that: 1. Local RGC+ loss is associated with local VF sensitivity loss as long as the displacement of RGCs from the foveal center is taken into consideration; and 2. Macular damage is typically arcuate in nature and often associated with local RNFL thinning in a narrow region of the disc, which we call the macular vulnerability zone (MVZ). According to our schematic model of macular damage, most of the inferior region of the macula projects to the MVZ, which is located largely in the inferior quadrant of the disc, a region that is particularly susceptible to glaucomatous damage. A small (cecocentral) region of the inferior macula, and all of the superior macula (inferior VF), project to the temporal quadrant, a region that is less susceptible to damage. The overall message is clear; clinicians need to be aware that glaucomatous damage to the macula is common, can occur early in the disease, and can be missed and/or underestimated with standard VF tests that use a 6° grid, such as the 24-2 VF test.
Recommended Citation
Hood, D., Raza, A., de Moraes, C., Liebmann, J. M., & Ritch, R. (2013). Glaucomatous Damage of the Macula. Progress in Retinal and Eye Research, 32, 1-21. https://doi.org/10.1016/j.preteyeres.2012.08.003