Does the Enlargement of Retinal Nerve Fiber Layer Defects Relate to Disc Hemorrhage or Progressive Visual Field Loss in Normal-tension Glaucoma

Journal of Glaucoma, 03/16/2011

Nitta K et al. - The enlargement of retinal nerve fiber layer defects (RNFLD) in normal-tension glaucoma (NTG) was closely associated with Disc hemorrhage (DH) occurrence and the deterioration of visual field.


  • Authors reviewed NTG patients that were diagnosed and followed up for at least 3 years at 1-month to 2-month intervals by the same examiner, and selected eyes with distinct RNFLD borders.
  • Using fundus photographs, for which authors extracted only a blue ingredient and processed it into black and white, they measured RNFLD angles.
  • NTG cases were divided into 2 groups, enlarged RNFLD and stable RNFLD, and clinical characteristics were compared between both groups.


  • 93 eyes from 93 patients (mean follow-up, 8.2 y) were selected.
  • Enlargement of RNFLD was detected in 55 eyes.
  • DH was found in 35 of 55 eyes (63.6%) in the enlarged group and in 6 of 38 eyes (15.8%) in the stable group (P<0.0001).
  • 21 eyes (38.2%) from the enlarged group exhibited recurrent DH.
  • In 48 eyes (87.3%) from the enlarged group, the enlargement of RNFLD was toward the fovea.
  • When DHs located apart from RNFLD were excluded, RNFLD enlarged in the direction of DH in 21 of 25 eyes (84.0%).
  • The cumulative probability of non progression in the visual field was significantly lower in the enlarged group (10–year survival rate: 0.52±0.11) than in the stable group (10-year survival rate: 0.89±0.08) (P=0.0019).

Print Article Summary Cat 2 CME Report