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Scanning Laser Polarimetry, Nerve Fiber Photography, and Perimetry in the Diagnosis of Glaucomatous Nerve Fiber Bundle Defects

1Kremmer S., 2Ayertey H. D., 1Niederdräing N., 3Steuhl K. P., 1Selbach J. M.,
1Universität-Gesamthochschule Essen, Zentrum für Augenheilkunde (Essen)
2Universität zu Köln, Zentrum für Augenheilkunde (Köln)
3Universität-Gesamthochschule Essen, Zentrum für Augenheilkunde, Abt. für Erkrankungen des vorderen Augenabschnitts (Essen)

Purpose: In glaucoma, the retinal nerve fiber layer is damaged. Whereas severe defects can be easily found the detection of localised retinal nerve fiber bundle (RNFB) defects can be difficult. In the present study, we compared the ability of scanning laser polarimetry (SLP), retinal nerve fiber layer photography (NFP), and perimetry to detect RNFB defects of different sizes in normal tension (NTG) and primary open angle glaucoma (POAG) patients.
Method: 99 glaucoma patients were included (POAG: n=43, mean age 63.9 years; NTG: n=56, mean age 64 years). SLP (GDx, software version 2.0.10, LDT, USA), NFP (Zeiss Ikon fundus camera 30°, green filter), automated perimetry (Oculus TAP cc2000) and standard ophthalmologic examinations were performed. According to Quigley we used a semi-quantitative NFP grading system. Localized RNFB defects were evaluated with regards to localisation and size: 1 hour (slit-), 2 hours (wedge-) and 3 hours (quadrant-defects) for SLP and NFP. In perimetry, we assessed defect localisation.
Results: In POAG, 11/6/5 localized RNFB defects could be detected by SLP/NFP/perimetry, respectively, consisting of 5/3 slit, 4/3 wedge and 2/0 quadrant defects in SLP/NFP, respectively. In NTG, 10/7/5 localized RNFB defects were found by SLP/NFP/perimetry, respectively, consisting of 4/5 slit, 5/2 wedge and 1/0 quadrant defects in SLP/NFP, respectively. Most localized RNFB were found in stage D2: in NTG 2 slit, 3 wedge and 1 quadrant defects, and in POAG 4 slit, 2 wedge and 2 quadrant defects. In NTG/POAG, SLP and NFP showed concomittant localisation of RNFB defects in 6/6 patients.
Conclusions: Most NFBD were detected at moderate glaucomatous damage (stage D2). To compare findings of different techniques it seems to be of great importance to classify the size of NFBD before evaluation. Our results show that SLP has the potential to detect RNFB defects of different size and localisation.