Mapping structural to functional damage in glaucoma with standard automated perimetry and confocal scanning laser ophthalmoscopy

PURPOSE: To develop a quantitative method for analysis of the topographic relationship between structural and functional damage in patients with glaucoma. METHODS: We studied 26 patients with primary open-angle glaucoma, focal optic disk damage, and focal visual field loss. The visual field was evaluated with automated perimetry, and the optic disk topography was assessed with a confocal scanning laser ophthalmoscope. Topographic measurements were calculated in 10-degree sectors and compared with a normative database (n = 52). The topographic relationship of structural damage and functional loss was analyzed. RESULTS: Rim area ratio was defined as the ratio of rim area in each 10-degree sector divided by the total rim area. This ratio resulted in the identification of one (46%) or more (54%) clusters of optic disk sectors as outside normal limits in all 26 patients (12 and 14-patients, respectively). Twenty-two patients (84%) with superior hemi-field sensitivity loss tended to have inferior rim defects, and vice versa. Nasal visual field defects close to the horizontal midline were matched with damaged rim areas close to the vertical midline. CONCLUSIONS: This mapping method allows an objective and quantitative evaluation of the optic disk and visual field in patients with glaucoma and focal damage, Although the topographic relationship between structure and function is characterized by considerable interindividual variability, the identification of certain patterns may be useful to aid in the evaluation of glaucomatous damage. (C) 1998 by Elsevier Science Inc. All rights reserved.