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Spatial Summation in the Glaucomatous Macula: A Link With Retinal Ganglion Cell Damage

Montesano, G. ORCID: 0000-0002-9148-2804, Redmond, T., Mulholland, P. J. , Garway-Heath, D. F., Ometto, G. ORCID: 0000-0002-0900-4847, Romano, D., Antonacci, F., Tanga, L., Carnevale, C., Rossetti, L. M., Crabb, D. P. ORCID: 0000-0001-8611-1155 & Oddone, F. (2023). Spatial Summation in the Glaucomatous Macula: A Link With Retinal Ganglion Cell Damage. Investigative Ophthalmology & Visual Science, 64(14), article number 36. doi: 10.1167/iovs.64.14.36


PURPOSE: The purpose of this study was to test whether functional loss in the glaucomatous macula is characterized by an enlargement of Ricco's area (RA) through the application of a computational model linking retinal ganglion cell (RGC) damage to perimetric sensitivity.

METHODS: One eye from each of 29 visually healthy subjects <40 years old, 30 patients with glaucoma, and 20 age-similar controls was tested with a 10-2 grid with stimuli of 5 different area sizes. Structural estimates of point-wise RGC density were obtained from optical coherence tomography (OCT) scans. Structural and functional data from the young healthy cohort were used to estimate the parameters of a computational spatial summation model to generate a template. The template was fitted with a Bayesian hierarchical model to estimate the latent RGC density in patients with glaucoma and age-matched controls. We tested two alternative hypotheses: fitting the data by translating the template horizontally (H1: change in RA) or vertically (H2: loss of sensitivity without a change in RA). Root mean squared error (RMSE) of the model fits to perimetric sensitivity were compared. Ninety-five percent confidence intervals were bootstrapped. The dynamic range of the functional and structural RGC density estimates was denoted by their 1st and 99th percentiles.

RESULTS: The RMSE was 2.09 (95% CI = 1.92-2.26) under H1 and 2.49 (95% CI = 2.24-2.72) under H2 (P < 0.001). The average dynamic range for the structural RGC density estimates was only 11% that of the functional estimates.

CONCLUSIONS: Macular sensitivity loss in glaucoma is better described by a model in which RA changes with RGC loss. Structural measurements have limited dynamic range.

Publication Type: Article
Additional Information: This work is licensed under a Creative Commons Attribution 4.0 International License.
Subjects: R Medicine > RE Ophthalmology
Departments: School of Health & Psychological Sciences > Optometry & Visual Sciences
SWORD Depositor:
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Available under License Creative Commons: Attribution International Public License 4.0.

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