LAUSR

OBJECTIVE To apply retinal nerve fiber layer (RNFL) optical texture analysis (ROTA) in eyes with early glaucoma to investigate (1) the pattern of RNFL defects, (2) how often the papillomacular bundle and papillofoveal bundles were involved, and (3) the association between papillomacular/papillofoveal bundle defects and visual field (VF) sensitivity abnormalities. DESIGN Cross-sectional study PARTICIPANTS: 204 early glaucomatous eyes (VF mean deviation ≥-6dB) with RNFL defects from 171 consecutively enrolled glaucoma patients. METHODS All eyes had 24-2 VF test and optical coherence tomography imaging for ROTA. The borders of RNFL defects were delineated from ROTA and the involvement of the arcuate bundle, papillomacular bundle (i.e., bundles from the macula, excluding the fovea), and papillofoveal bundle (i.e., bundles from the fovea) was determined for each eye. Multilevel logistic regression analysis was applied to evaluate the structure-function association. MAIN OUTCOME MEAUSRES Proportions of eyes with papillomacular/papillofoveal bundle defects; odds ratio of VF sensitivity abnormalities in eyes with papillomacular/papillofoveal bundle defects RESULTS: 71.6% and 17.2% of eyes had RNFL defects involving the papillomacular bundle and the papillofoveal bundle, respectively; 25.0% had arcuate bundle defects without involvement of papillomacular and papillofoveal bundles. The pattern of RNFL defects was diverse; the most common one was concomitant involvement of the inferior arcuate bundle and the inferior papillomacular bundle (20.6%). Papillomacular/papillofoveal bundle defects were not associated with VF defects (i.e., with ≥3 contiguous locations with abnormal VF sensitivity in the pattern deviation probability plot) in the corresponding hemifield although VF sensitivity of any one of the central 4 VF locations of the 24-2 test, which corresponded to the central 12° of the macula, was more likely to be abnormal (P<5% in the pattern deviation probability plot) (odds ratio: 12.5, 95% CI: 7.0-22.5) when the VF stimulus was projected onto a papillomacular/papillofoveal bundle defect compared with that projected onto an intact papillomacular/papillofoveal bundle. CONCLUSION Contrary to the conventional notion that the fovea and macula are not affected until the late stages of glaucoma, papillofoveal/papillomacular bundle defects were common in early glaucoma, and they were associated with central VF sensitivity loss at the corresponding VF test locations.