Background/aims To identify whether an intact retinal nerve fibre layer (RNFL) thickness profile could determine the location of the earliest RNFL defect in glaucoma. Methods Retrospective longitudinal cohort study of patients with initial unilateral glaucoma who eventually developed new glaucoma in the fellow eye. Guided progression analysis (GPA) of serial optical coherence tomography (OCT) examinations was used to identify the angular locations of the earliest RNFL defect, peak and temporal edge of the baseline RNFL profile and major vessels based on the peripapillary OCT scan circle. Results We identified 112 new RNFL defects in 109 fellow eyes of 109 consecutive patients. The locations of new defects were superotemporal (22 eyes), inferotemporal (87 eyes) and papillomacular bundle (3 eyes), respectively. Overall, the midpoint location of the earliest RNFL defect strongly coincided with the RNFL peak (p<0.001). Specifically, the location was mildly (4.3±12.0°) temporal to, rather than at the peak thickness, particularly in eyes with a focal thinning pattern of arcuate bundles (7.8±10.8°). The close topographical relationship was consistent regardless of the interindividual variability in the RNFL profile and vessels, as well as hemispheric locations, and after adjusting for potential factors including age, refractive error, baseline intraocular pressure, tilt ratio, tilt axis and glaucoma diagnosis. Conclusion The location of the earliest RNFL defect in glaucoma showed a close relationship with the intact RNFL profile within the same eye, regardless of variations in RNFL, hemispheric location and vessel distribution. In addition, the earliest defect was located mildly temporal to, rather than at, the peak RNFL thickness. The baseline RNFL profile may have a significant role in the regional vulnerability of glaucoma. Data are available upon reasonable request.

中文翻译：

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青光眼性视网膜神经纤维损伤的最早位置由完整的基线 RNFL 厚度曲线确定


背景/目的 确定完整的视网膜神经纤维层 （RNFL） 厚度剖面是否可以确定青光眼中最早的 RNFL 缺损的位置。方法 对最终在对侧眼发展为新发青光眼的初始单侧青光眼患者进行回顾性纵向队列研究。采用连续光学相干断层扫描 （OCT） 检查的引导进展分析 （GPA） 确定最早 RNFL 缺损的角度位置、基线 RNFL 轮廓的峰值和颞缘以及基于周围 OCT 扫描圈的主要血管。结果 我们在 109 例连续患者的 109 只对侧眼中发现了 112 例新的 RNFL 缺陷。新缺损的位置分别为颞上 （22 眼） 、颞下 （87 眼） 和黄斑束 （3 眼）。总体而言，最早的 RNFL 缺陷的中点位置与 RNFL 峰 （p<0.001） 非常吻合。具体来说，该位置是轻微的 （4.3±12.0°） 时间到峰值厚度，而不是在峰值厚度处，特别是在具有弧状束局灶性变薄模式 （7.8±10.8°） 的眼睛中。无论 RNFL 剖面和血管以及半球位置的个体间变异性如何，并且在调整了包括年龄、屈光不正、基线眼压、倾斜比、倾斜轴和青光眼诊断在内的潜在因素后，密切的地形关系是一致的。结论 青光眼中最早的 RNFL 缺损位置与同一只眼睛内的完整 RNFL 轮廓密切相关，与 RNFL 、半球位置和血管分布的变化无关。此外，最早的缺损位于 RNFL 峰值厚度的轻微时间位置，而不是位于 RNFL 峰值厚度处。 基线 RNFL 概况可能在青光眼的区域易感性中起重要作用。数据可根据合理要求提供。