Retinal nerve fibre layer optical texture analysis: retinal nerve fibre bundle defect patterns and the extent of macular involvement across different stages of glaucoma.

Abstract

To apply retinal nerve fibre layer (RNFL) optical texture analysis (ROTA) to investigate (1) the patterns of RNFL bundle defects, and (2) the frequency of papillomacular and papillofoveal bundle involvement across early, moderate and advanced glaucoma. All eyes underwent 24-2 visual field (VF) testing and optical coherence tomography (OCT) for ROTA. The borders of RNFL defects were delineated from ROTA, and the involvement of the arcuate, papillomacular and papillofoveal bundles was determined for each eye. 24-2 VF stimulus projections were mapped onto the corresponding topographic areas of ROTA images. Multilevel logistic regression analysis was applied to evaluate the structure-function association. Papillomacular bundle defects were highly prevalent in glaucoma, increasing from 87.7% in early to 95.35% in moderate and 100% in advanced glaucoma. Papillofoveal bundle defects were also common, increasing from 29.7% in early to 36.05% in moderate and 60.98% in advanced glaucoma. Central four 24-2 test locations that projected onto the trajectories of papillomacular or papillofoveal RNFL bundle defects demonstrated significantly increased likelihood of VF sensitivity abnormality (ORs of 22.42 at PDP<5% and 20.26 at TDP<5%, respectively, p<0.001 for both). ROTA uncovers a wide spectrum of RNFL bundle defects spanning the entire glaucoma continuum. It also provides visualisation of the preserved RNFL bundles in advanced glaucoma. Papillomacular and papillofoveal RNFL bundle defects are present in a considerable proportion of eyes with early, moderate and advanced glaucoma, and, when detected, they significantly increase the likelihood of abnormality in the corresponding central 24-2 test locations.