Oximetry in glaucoma: correlation of metabolic change with structural and functional damage

Abstract. Purpose: To determine whether retinal vessel oxygen saturation in patients with glaucoma is associated with structural optic disc and retinal nerve fibre layer (RNFL) changes and visual field (VF) defects. Methods: Fifty-nine patients with confirmed glaucoma were recruited at University Hospitals Leuven. Retinal oxygen saturation in patients with glaucoma was measured with a noninvasive spectrophotometric retinal oximeter (Oxymap ehf, Reykjavik, Iceland). VF and Heidelberg retinal tomographies (HRTs) were performed on the same day. Statistical analysis was performed using Student's t-test and Pearson's or Spearman correlation coefficient. Results: The mean oxygen saturation in venules was higher in patients with severe VF defects compared to those patients with mild VF defects (69 +/- 3% versus 65 +/- 6% respectively; p = 0.0003; n = 59). Accordingly, the arteriovenous (AV) difference in oxygen saturation was lower in patients with worse VF compared to those with better VF (29 +/- 3% versus 33 +/- 6% respectively; p = 0.002). The oxygen saturation in venules correlated with the VF mean defects (r = -0.42; p = 0.001; n = 59) as well as with the structural HRT parameters rim area and RNFL thickness (r = -0.39; p = 0.008 and r = -0.26; p = 0.05 respectively; n = 53). The AV difference decreased significantly as the VF defect worsened (r = 0.38; p = 0.003), as the rim area diminished (r = 0.29; p = 0.03) and as the RNFL thickness decreased (r = 0.27; p = 0.05). No correlation was found between the oxygen saturation in retinal arterioles and either of these parameters. Conclusion: Severe glaucomatous damage is associated with increased oxygen saturation in retinal venules and decreased AV difference in oxygen saturation. These data suggest that in eyes with severe glaucomatous damage, reduced retinal oxygen consumption is consistent with tissue loss.