Increased Equivalent Input Noise in Glaucomatous Central Vision: Is it Due to Undersampling of Retinal Ganglion Cells?

Purpose: Recent evidence shows that macular damage is common even in early stages of glaucoma. Here we investigated whether contrast sensitivity loss in the central vision of glaucoma patients is due to an increase in equivalent input noise (Neq), a decrease in calculation efficiency, or both. We also examined how retinal undersampling resulting from loss of retinal ganglion cells (RGCs) may affect Neq and calculation efficiency. Methods: This study included 21 glaucoma patients and 23 age-matched normally sighted individuals. Threshold contrast for orientation discrimination was measured with a sinewave grating embedded in varying levels of external noise. Data were fitted to the linear amplifier model (LAM) to factor contrast sensitivity into Neq and calculation efficiency. We also correlated macular RGC counts estimated from structural (spectral-domain optical coherence tomography) and functional (standard automated perimetry Swedish interactive thresholding algorithm 10-2) data with either Neq or efficiency. Furthermore, using analytical and computer simulation approach, the relative effect of retinal undersampling on Neq and efficiency was evaluated by adding the RGC sampling module into the LAM. Results: Compared with normal controls, glaucoma patients exhibited a significantly larger Neq without significant difference in efficiency. Neq was significantly correlated with Pelli-Robson contrast sensitivity and macular RGC counts. The results from analytical derivation and model simulation further demonstrated that Neq can be expressed as a function of internal noise and retinal sampling. Conclusions: Our results showed that equivalent input noise is significantly elevated in glaucomatous vision, thereby impairing foveal contrast sensitivity. Our findings further elucidated how undersampling at the retinal level may increase equivalent input noise.