Systemic Vascular Risk Factors for Multiple Retinal Nerve Fiber Layer Defects

Multiple retinal nerve fiber layer (RNFL) defects develop uncommonly, even though glaucomatous RNFL loss is typically observed as one RNFL defect in each quadrant. We investigated the risk factors associated with multiple RNFL defects to increase our understanding of the nature and pathogenesis of various RNFL defect patterns. Data from subjects with multiple RNFL defects (28 patients) and glaucoma patients without multiple RNFL defects (194 patients) were analyzed. The term multiple RNFL defects refers to three or more isolated defects separated by a comparatively normal area. Patients with multiple RNFL defects showed a higher prevalence of hypertension, end-stage renal disease, and cerebrovascular disease than those without multiple RNFL defects, both before and after propensity score matching for age and mean deviation (all P < 0.05). The number of patients with parafoveal visual field points depressed <5% on pattern deviation plots was higher in subjects with multiple RNFL defects than in those without multiple RNFL defects (P = 0.048). In conclusion, the presence of multiple RNFL defects had clinical relevance for systemic vascular risk factors and a higher risk of parafoveal scotoma. Clinicians should be aware of the possibility of concomitant systemic vascular disease when evaluating patients with multiple RNFL defects.