title: Sectoral analysis of the retinal nerve fiber layer thinning and its association with visual field loss in homonymous hemianopia caused by post-geniculate lesions using spectral-domain optical coherence tomography.
abstract: OBJECTIVE
  To report a sectoral analysis of circumpapillary retinal nerve fiber layer (cpRNFL) thinning and its association with visual field loss using spectral-domain optical coherence tomography (SD-OCT) in patients with homonymous hemianopia following acquired post-geniculate visual pathway damage.
  
  
  METHODS
  Seven patients with homonymous hemianopia due to unilateral acquired post-geniculate visual pathway lesions were studied. The average duration from the onset of brain lesions to the initial visit was 49.8 months. Forty-nine normal control subjects without visual field defects, as confirmed using a Humphrey visual field analyzer, were also enrolled. Measurement of the cpRNFL thickness was performed at the initial visit and 24 months using SD-OCT (RTVue-100® OCT). The cpRNFL thickness was divided into eight sectors (superior temporal: ST, temporal upper: TU, temporal lower: TI, inferior temporal: IT, inferior nasal: IN, nasal lower: NL, nasal upper: NU, superior nasal: SN). The eye on the same side as the occipital lobe lesions was defined as the ipsilateral eye, and the eye on the opposite side was defined as the contralateral eye.
  
  
  RESULTS
  The average cpRNFL thickness in the homonymous hemianopic eyes was significantly reduced as compared with that seen in the normal controls, except for the ipsilateral eyes at the initial visit. Four of the eight sectors of the cpRNFL thickness in the homonymous hemianopic eyes were significantly reduced compared with that noted in the normal controls. In the ipsilateral eyes, the cpRNFL thickness in the ST, TU, TL, and IT sectors was significantly reduced at both the initial visit and 24 months. In the contralateral eyes, the cpRNFL thickness in the TU, TL, IT, and SN sectors was significantly reduced at both the initial visit and 24 months. The reduction of the quadrantic cpRNFL thickness significantly correlated with some of the visual field parameters, in accordance with the structure-function relationship. In the contralateral eyes, the T and I quadrant cpRNFL thickness correlated with the mean deviation and hemianopic field total deviation at 24 months. In the ipsilateral eyes, the S, T, and I quadrant cpRNFL thickness correlated with mean deviation. However, there were no correlations between the cpRNFL thickness and visual field parameters at the initial visit.
  
  
  CONCLUSIONS
  A reduction of the cpRNFL thickness corresponding to the hemianopic visual field loss due to acquired post-geniculate visual pathway lesions was detected using SD-OCT, and the change was more evident at 24 months than at the initial visit. The latter finding suggests that this change is, at least partially, caused by transsynaptic retrograde degeneration.
authors.affiliation: Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki city, Okayama, Japan, 701-0192.|Doctoral Program in Sensory Science, Graduate School of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Japan.
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Goto
authors.affiliation: Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki city, Okayama, Japan, 701-0192. amiki@tc5.so-net.ne.jp.|Department of Sensory Science, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Japan. amiki@tc5.so-net.ne.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Miki
authors.affiliation: Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki city, Okayama, Japan, 701-0192.|Department of Sensory Science, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yamashita
authors.affiliation: Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki city, Okayama, Japan, 701-0192.
authors.forename: Syunsuke
authors.initials: S
authors.lastname: Araki
authors.affiliation: Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki city, Okayama, Japan, 701-0192.
authors.forename: Go
authors.initials: G
authors.lastname: Takizawa
authors.affiliation: Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki city, Okayama, Japan, 701-0192.
authors.forename: Masaki
authors.initials: M
authors.lastname: Nakagawa
authors.affiliation: Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki city, Okayama, Japan, 701-0192.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ieki
authors.affiliation: Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki city, Okayama, Japan, 701-0192.
authors.forename: Junichi
authors.initials: J
authors.lastname: Kiryu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006423:Hemianopsia / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D020762:Infarction, Posterior Cerebral Artery / Q000150:complications* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009778:Occipital Lobe / Q000503:physiopathology; D009901:Optic Nerve Diseases / Q000150:complications* / Q000175:diagnosis; D012165:Retinal Ganglion Cells / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000175:diagnosis*; D058609:Visual Field Tests; D014794:Visual Fields; D014795:Visual Pathways / Q000473:pathology
keywords: Circumpapillary retinal nerve fiber layer; Homonymous hemianopia; Post-geniculate visual pathway; Spectral-domain optical coherence tomography; Transsynaptic retrograde degeneration