title: Does the enlargement of retinal nerve fiber layer defects relate to disc hemorrhage or progressive visual field loss in normal-tension glaucoma?
abstract: OBJECTIVE
  We investigated the difference in clinical characteristics between cases with enlarged retinal nerve fiber layer defects (RNFLD) and stable RNFLDs in normal-tension glaucoma (NTG).
  
  
  METHODS
  We retrospectively 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 we extracted only a blue ingredient and processed it into black and white, we measured RNFLD angles and divided NTG cases into 2 groups, enlarged RNFLD and stable RNFLD, and compared the clinical characteristics between both groups.
  
  
  RESULTS
  Ninety-three eyes from 93 patients (mean follow-up, 8.2 y) were selected and enlargement of RNFLD was detected in 55 eyes. Disc hemorrhage (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). Twenty-one 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).
  
  
  CONCLUSIONS
  The enlargement of RNFLD in NTG was closely associated with DH occurrence and the deterioration of visual field.
authors.affiliation: Fukui-ken Saiseikai Hospital, Funabashi, Fukui, Japan. k-nitta@fukui.saiseikai.or.jp
authors.forename: Koji
authors.initials: K
authors.lastname: Nitta
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Sugiyama
authors.forename: Tomomi
authors.initials: T
authors.lastname: Higashide
authors.forename: Shinji
authors.initials: S
authors.lastname: Ohkubo
authors.forename: Toshiro
authors.initials: T
authors.lastname: Tanahashi
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kitazawa
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D057066:Low Tension Glaucoma / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012166:Retinal Hemorrhage / Q000175:diagnosis*; D012189:Retrospective Studies; D014786:Vision Disorders / Q000175:diagnosis*; D058609:Visual Field Tests; D014794:Visual Fields