Modeling the patterns of visual field loss in glaucoma.
OBJECTIVE
A computer model was developed to test the assumption that diffuse neural loss can result in the field loss pattern characteristic of glaucoma.


METHODS
The anterior visual pathways comprised the retinal ganglion cells, and their axons up to the optic nerve head (ONH) were modeled in a computer program. Axon resistance to stress was accounted for depending on the location on the ONH, taking into consideration the presence or absence of vessels in the area. Damage patterns were applied to the axons at the ONH, and the corresponding dendritic fields were removed accordingly. A visual field was extracted and represented on a gray scale after a predetermined stage of damage was reached. Two patterns of damage were considered, a diffuse damage produced by randomly removing fibers and an ordered anteroposterior elimination.


RESULTS
Random damage never rendered a pattern loss. Ordered centrifugal fiber loss may produce a radial pattern more conspicuous when the vessels are endowed with a protective role. In both cases, scotomas tend to be detectable earlier in more peripheral locations, attributable to the increasing size of the receptive fields with eccentricity.


CONCLUSIONS
The model shows that pattern loss typical of glaucoma cannot be solely the result of a random loss of fibers. Anteroposterior damage of the ONH can explain radial progression of scotomas if a protective role is introduced for the central vessels.
Department of Surgery (Ophthalmology), School of Medicine, University of Granada, Granada, Spain. fjcarreras@telefonica.net
Francisco J
FJ
Carreras
Raúl
R
Rica
Angel V
AV
Delgado
D001369:Axons; D001808:Blood Vessels / Q000503:physiopathology; D003198:Computer Simulation; D018450:Disease Progression; D005901:Glaucoma / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D009898:Optic Disk / Q000098:blood supply / Q000503:physiopathology; D012165:Retinal Ganglion Cells; D012607:Scotoma / Q000209:etiology; D014794:Visual Fields; D014795:Visual Pathways / Q000503:physiopathology