Retinal Ganglion Cell Loss and Patterns of Neuroretinal Rim Thinning at the Onset of Visual Field Defects in Glaucoma

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-09-06 DOI:10.1016/j.ajo.2025.09.008

Aaron Samuel Rabinowitz, Verônica Vilasboas-Campos, Marcus Guerreiro Filho, Felipe A. Medeiros

{"title":"Retinal Ganglion Cell Loss and Patterns of Neuroretinal Rim Thinning at the Onset of Visual Field Defects in Glaucoma","authors":"Aaron Samuel Rabinowitz, Verônica Vilasboas-Campos, Marcus Guerreiro Filho, Felipe A. Medeiros","doi":"10.1016/j.ajo.2025.09.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>To compare retinal ganglion cell (RGC) loss in glaucoma suspect eyes with diffuse versus localized neuroretinal rim loss at the time of the first confirmed visual field defect.</div></div><div><h3>Design</h3><div>Prospective observational cohort study.</div></div><div><h3>Subjects</h3><div>Fifty-three glaucoma suspect eyes and 124 healthy eyes.</div></div><div><h3>Methods</h3><div>Fifty-three glaucoma suspect eyes were followed until development of repeatable glaucomatous visual field defects. Estimated RGC counts were derived using a validated model combining standard automated perimetry and optical coherence tomography measurements. Conversion was defined as the first confirmed abnormal field, with RGC estimates taken within three months. Neuroretinal rim loss was classified as diffuse or localized through masked grading of optic disc stereophotographs. A normative cohort of 124 healthy eyes provided reference RGC values.</div></div><div><h3>Main Outcome Measures</h3><div>Estimated RGC counts at perimetric conversion.</div></div><div><h3>Results</h3><div>Of the 53 eyes, 36 (68%) showed diffuse and 17 (32%) localized rim loss. Eyes with diffuse loss had significantly lower RGC counts at conversion (613 543 ± 114 886) than those with localized loss (733 614 ± 65 776, <em>P</em> < .001), corresponding to a 32.6% and 19.4% mean reduction relative to healthy controls, respectively. Mean deviation differed modestly between groups (–2.44 ± 1.36 dB vs –1.62 ± 1.13 dB, <em>P</em> = .033) at time of conversion. Multivariable analysis identified diffuse rim loss, older age, and Black race as independent predictors of lower RGC counts.</div></div><div><h3>Conclusions</h3><div>Diffuse rim thinning at the earliest stage of functional loss is associated with substantially greater RGC loss than localized thinning. These findings support incorporating structural features into early glaucoma assessment.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"281 ","pages":"Pages 42-51"},"PeriodicalIF":4.2000,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0002939425004751","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

To compare retinal ganglion cell (RGC) loss in glaucoma suspect eyes with diffuse versus localized neuroretinal rim loss at the time of the first confirmed visual field defect.

Design

Prospective observational cohort study.

Subjects

Fifty-three glaucoma suspect eyes and 124 healthy eyes.

Methods

Fifty-three glaucoma suspect eyes were followed until development of repeatable glaucomatous visual field defects. Estimated RGC counts were derived using a validated model combining standard automated perimetry and optical coherence tomography measurements. Conversion was defined as the first confirmed abnormal field, with RGC estimates taken within three months. Neuroretinal rim loss was classified as diffuse or localized through masked grading of optic disc stereophotographs. A normative cohort of 124 healthy eyes provided reference RGC values.

Main Outcome Measures

Estimated RGC counts at perimetric conversion.

Results

Of the 53 eyes, 36 (68%) showed diffuse and 17 (32%) localized rim loss. Eyes with diffuse loss had significantly lower RGC counts at conversion (613 543 ± 114 886) than those with localized loss (733 614 ± 65 776, P < .001), corresponding to a 32.6% and 19.4% mean reduction relative to healthy controls, respectively. Mean deviation differed modestly between groups (–2.44 ± 1.36 dB vs –1.62 ± 1.13 dB, P = .033) at time of conversion. Multivariable analysis identified diffuse rim loss, older age, and Black race as independent predictors of lower RGC counts.

Conclusions

Diffuse rim thinning at the earliest stage of functional loss is associated with substantially greater RGC loss than localized thinning. These findings support incorporating structural features into early glaucoma assessment.

查看原文本刊更多论文

青光眼视野缺损发病时视网膜神经节细胞丢失和神经视网膜边缘变薄的模式。

目的比较首次确认视野缺损时，视网膜神经节细胞（RGC）丧失与弥漫性和局限性神经视网膜边缘丧失的青光眼疑似眼的情况。前瞻性观察队列研究。受试者：53只疑似青光眼和124只健康眼。方法对53只疑似青光眼进行随访，直至出现可重复青光眼视野缺损。估计的RGC计数是通过一个经过验证的模型得到的，该模型结合了标准的自动周边测量和光学相干断层扫描测量。转换被定义为第一个确认的异常油田，RGC在三个月内进行了估计。通过视盘立体照片的模糊分级，将神经视网膜边缘损失分类为弥漫性或局域性。124只健康眼睛的标准队列提供了参考RGC值。主要观察指标：围周转换时估计的RGC计数。结果53只眼中弥漫性眼缘丢失36只（68%），局限性眼缘丢失17只（32%）。弥漫性损失眼的RGC计数（613,543±114,886）明显低于局限性损失眼（733,614±65,776,P < 0.001），相对于健康对照，分别平均减少32.6%和19.4%。转换时，两组间的平均偏差差异不大（-2.44±1.36 dB vs -1.62±1.13 dB, P = 0.033）。多变量分析发现弥漫性边缘丧失、年龄较大和黑人种族是RGC计数较低的独立预测因素。结论在功能丧失早期弥漫性边缘变薄与RGC损失的相关性明显大于局部变薄。这些发现支持将结构特征纳入早期青光眼评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.