Correlation of optic nerve head tomography with visual field sensitivity in papilledema

PURPOSE. To quantify the relationship between optic nerve head tomography a nd perimetric sensitivity in patients with papilledema. METHODS. Eight patients with variable degrees of recently diagnosed papille dema associated with idiopathic intracranial hypertension OIH) were evaluat ed with confocal scanning laser ophthalmoscopy (CSLO) and automated perimet ry. Patients were followed up with serial measurements over a period of 5 t o 30 months (mean +/- SD, 17.1 +/- 9), while under medical treatment (aceta zolamide). The tomographic parameters, volume above reference (VAR), volume above surface (VAS), effective mean height (EMH), and maximum height in co ntour MxHC), were obtained by tomography, either globally or from predefine d disc sectors. The perimetric indices, mean deviation (MD) and pattern SD (PSD), were evaluated. The results from patients' right eyes and the indivi dual intereye differences in both tomographic and perimetric parameters, we re statistically evaluated by nonparametric correlational (Spearman) and re peated measures (Wilcoxon) analyses. RESULTS. At baseline, all tomographic parameters were negatively correlated with MD in global (r = -0.8) and sectorial (r = -0.6) evaluations. The int erocular differences in overall tomographic parameters were correlated with corresponding differences in perimetric MD (r = -0.8) and PSD (r = 0.6). D uring the follow-up period, volumetric disc parameters decreased (P < 0.02) , whereas perimetric MD increased (P = 0.02) at comparable times. CONCLUSIONS. In patients with recently diagnosed papilledema, optic nerve h ead tomographic abnormalities are quantitatively correlated with visual fie ld sensitivity losses. Therapeutic improvement of volumetric parameters may be paralleled by recovery in perimetric sensitivity. The data support the possible use of both techniques in combination to monitor the amount of pap illedema and the effectiveness of treatments designed to reduce intracrania l hypertension.