Visual field damage in normal-tension glaucoma patients with or without ischemic changes in cerebral magnetic resonance imaging

To compare the pattern of visual field damage between normal-tension glaucoma (NTG) patients with signs indicative of ischemic changes and those NTG patients without signs of ischemic changes, using brain magnetic resonance imaging (MRI), in a single center, cross-sectional study. In 94 consecutive NTG patients who were younger than 61 years old, brain MRI images were obtained using fluid-attenuated inversion recovery pulse sequences. The presence of signs indicative of ischemic changes in brain MRI images was decided separately by two neuroradiologists masked to the diagnosis and stage of glaucoma. Visual field testing was performed using the 30-2 program of the Humphrey Visual Field Analyzer. Between the patients with signs indicative of ischemic changes in brain MRI (ischemic group) and those without MRI signs (nonischemic group), total deviation (TD) at each test point less the average of TDs of the 30-2 program ([TD - TD(mean)])--was compared at each test point. Signs indicative of ischemic changes in brain MRI were found in 32 of the 94 patients (34.0%). Age, blood pressure, refraction, intraocular pressure, the average of TDs, mean deviation, and corrected pattern standard deviation were not significantly different between the ischemic (N = 32) and nonischemic (N = 62) groups (P > 0.2). [TD - TD(mean)] in the ischemic group was significantly smaller than that in the nonischemic group at 6 nonedge contiguous test points in the inferior pericentral to nasal field (P = 0.005-0.047). NTG patients with signs indicative of ischemic changes in brain MRI had a relatively deeper depression in the inferior pericentral visual field.