Macular Involvement and Central Structure-Function Association in Glaucoma with Retinal Nerve Fiber Layer Optical Texture Analysis

Abstract

<p><strong>Purpose </strong>: To apply retinal nerve fiber layer (RNFL) optical texture analysis (ROTA) to investigate the patterns and frequency of papillomacular and papillofoveal bundle involvement across early, moderate, and advanced glaucoma and their association with visual field (VF) sensitivity abnormalities on the 10-2 test.</p><p><strong>Methods </strong>: A total of 841 eyes (144 healthy, 317 glaucoma suspect, and 380 glaucoma) of 442 participants were included. All eyes underwent 24-2 and 10-2 VF testing and ROTA imaging. The borders of ROTA RNFL defects were delineated, and the involvement of the arcuate, papillomacular, and papillofoveal bundles was determined for each eye. 24-2 and 10-2 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.</p><p><strong>Results </strong>: Papillomacular bundle defects were highly prevalent in glaucoma increasing from 87.7% in early, to 95.4% in moderate, and 100% in advanced glaucoma. Papillofoveal bundle defects were also common in glaucoma increasing from 29.7% in early, to 36.1% in moderate, and 61.0% in advanced glaucoma. 24-2 test locations that projected onto the trajectories of RNFL bundle defects demonstrated a significantly increased likelihood of VF sensitivity abnormality (ORs of 13.19 at pattern deviation probability (PDP) < 5%, and 16.14 at total deviation probability (TDP) < 5%, respectively, <em>P</em> < 0.001 for both). A 10-2 VF location that was projected onto a papillomacular or a papillofoveal RNFL bundle defect had a significantly increased likelihood of reduced sensitivity (ORs of 18.61 at PDP < 5%, and 20.17 at TDP < 5%, respectively, <em>P</em> < 0.001 for both).</p><p><strong>Conclusions </strong>: ROTA uncovers a wide spectrum of RNFL bundle defects spanning the entire glaucoma continuum and provides visualization of 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, significantly increase the likelihood of central VF abnormality. Enhanced uncovering of the extent of macular damage with ROTA can guide glaucoma management by identifying individuals who should be monitored with a 10-2 VF test.</p>