Preperimetric open angle glaucoma (OAG) in eyes that develop the disease at an early age compared to those that develop OAG at a more advanced age showed different optical coherence tomography (OCT) imaging characteristics. A younger person’s eye had thinner tissue in the inferior and superior quadrants, but aging eyes had thicker tissue in both. Improved glaucoma diagnosis and monitoring may be possible if researchers can better understand the distinct patterns of early glaucomatous damage dependent on age at onset.

The objective was to use optical coherence tomography to examine the differences in thinning of the retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) between patients with preperimetric OAG who developed the disease at a young age (<40 years old) and those who developed it at a more advanced age (≥40 years old). In order to create a “deviation frequency map,” Cirrus HD-optical coherence tomography was used to first obtain pictures of the RNFL and GCIPL, and then to superimpose these images. RNFL and GCIPL thickness measures were compared, along with their respective topographic thinning patterns and characteristics. About 194 eyes from 194 patients with preperimetric OAG and 97 eyes from 97 age-matched normal people were studied.

Eyes with preperimetric OAG that developed at a young age had predominantly inferotemporal RNFL deficiencies (264-296°) and inferior GCIPL faults (213–357°). GCIPL deficiencies in the inferior and superior regions accompanied RNFL deficits in the inferotemporal (266–294°) and superotemporal (33–67 degrees) directions in eyes with preperimetric OAG that developed with age (206–360 degrees, 0–22 degrees). Young-age-onset eyes had thinner RNFL and GCIPL thicknesses in the inferior quadrant compared to older-age-onset eyes (P=0.012, 0.016), while older-age-onset eyes had thinner thicknesses in the superior quadrant (P=0.003, 0.005). Preperimetric OAG can occur at any age, however there are distinct patterns of RNFL and GCIPL thinning in eyes that develop the disease at a young or old age.