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      Correlation between optic nerve head structural parameters and glaucomatous visual field indices

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          Abstract

          We examined associations between optic nerve head structural parameters and glaucomatous visual field indices. The study population included patients with glaucomatous optic neuropathy who were evaluated at Aichi Medical University, Nagakute, Aichi, Japan, from October 2010 to January 2011. A total of 57 eyes from 33 patients were assessed. We measured visual field using a Humphrey field analyzer, peripapillary retinal nerve fiber layer thickness (RNFL-T), and Bruch’s membrane opening-minimum rim width (BMO-MRW) using spectral domain optical coherence tomography, and rim area with referring three-dimensional photography. Spearman’s rank correlation coefficients were calculated between the threshold of visual sensitivity or total deviation of visual field and the following five optic nerve head structural parameters: RNFL-T length, BMO-MRW length, rim area, and calculated RNFL-T and BMO-MRW volumes (each length multiplied by rim area). The Akaike information criterion was calculated to determine which structural parameter was the best predictor of each visual field index. Threshold of visual sensitivity had correlation coefficients of 0.23 with global sector of RNFL-T, 0.32 with BMO-MRW, 0.14 with rim area, 0.21 with RNFL-T volume, and 0.26 with BMO-MRW volume. The correlation coefficients for each parameter with total deviation of visual field were 0.22, 0.33, 0.28, 0.36, and 0.37, respectively. The Akaike information criterion of BMO-MRW showed the smallest values in analyses of both threshold of visual sensitivity and total deviation. The present results show that RNFL-T volume and BMO-MRW volume were more strongly correlated with total deviation than BMO-MRW, but BMO-MRW appeared to be the best predictor of the two glaucomatous visual field indices.

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          Effect of myopia on the thickness of the retinal nerve fiber layer measured by Cirrus HD optical coherence tomography.

          To evaluate the effect of myopia on the peripapillary retinal nerve fiber layer (RNFL) thickness measured by Cirrus HD optical coherence tomography (OCT). Comprehensive ophthalmic examinations were performed, including measurement of visual acuity, refraction, and axial length on 269 subjects (age, 19-26 years) with no ophthalmic abnormality. Further, 200 x 200-cube optic disc scans of the subjects' eyes were obtained with Cirrus HD OCT. The RNFL thickness at 256 points of the RNFL thickness profile and the average RNFL thickness were recorded. The correlations between these values and the axial length and spherical equivalent (SE) of refractive errors were then analyzed by simple linear regression, before and after adjustment of the ocular magnification. Before ocular magnification adjustment, the uncorrected average RNFL thickness decreased as the axial length increased and as the SE decreased. However, after the adjustment, the corrected average RNFL thickness exhibited no correlation with the spherical equivalent and a weak positive correlation with the axial length. Myopia also affected the RNFL thickness distribution. As the axial length increased and the spherical equivalent decreased, the thickness of the temporal peripapillary RNFL increased and that of the superior, superior nasal, inferior, and inferior nasal peripapillary RNFL decreased. The axial length affected the average RNFL thickness, and myopia affected the RNFL thickness distribution. High myopes are likely to exhibit different RNFL distribution patterns. Since ocular magnification significantly affects the RNFL measurement in such patients, it should be considered in diagnosing glaucoma.
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            Enhanced detection of open-angle glaucoma with an anatomically accurate optical coherence tomography-derived neuroretinal rim parameter.

            Neuroretinal rim assessment based on the clinical optic disc margin (DM) lacks a sound anatomic basis for 2 reasons: (1) The DM is not reliable as the outer border of rim tissue because of clinically and photographically invisible extensions of Bruch's membrane (BM) inside the DM and (2) nonaccountability of rim tissue orientation in the optic nerve head (ONH). The BM opening-minimum rim width (BMO-MRW) is a parameter that quantifies the rim from its true anatomic outer border, BMO, and accounts for its variable orientation. We report the diagnostic capability of BMO-MRW. Case control. Patients with open-angle glaucoma (n = 107) and healthy controls (n = 48). Spectral-domain optical coherence tomography (SD-OCT) with 24 radial and 1 circumpapillary B-scans, centered on the ONH, and confocal scanning laser tomography (CSLT) were performed. The internal limiting membrane (ILM) and BMO were manually segmented in each radial B-scan. Three SD-OCT parameters were computed globally and sectorally: (1) circumpapillary retinal nerve fiber layer thickness (RNFLT); (2) BMO-horizontal rim width (BMO-HRW), the distance between BMO and ILM in the BMO reference plane; and (3) BMO-MRW, the minimum distance between BMO and ILM. Moorfields Regression Analysis (MRA) with CLST was performed globally and sectorally to yield MRA1 and MRA2, where "borderline" was classified as normal and abnormal, respectively. Sensitivity, specificity, and likelihood ratios (LRs) for positive and negative test results (LR+/LR-). The median (interquartile range) age and mean deviation of patients and controls were 69.9 (64.3-76.9) and 65.0 (58.1-74.3) years and -3.92 (-7.87 to -1.62) and 0.33 (-0.32 to 0.98) dB, respectively. Globally, BMO-MRW yielded better diagnostic performance than the other parameters. At 95% specificity, the sensitivity of RNFLT, BMO-HRW, and BMO-MRW was 70%, 51%, and 81%, respectively. The corresponding LR+/LR- was 14.0/0.3, 10.2/0.5, and 16.2/0.2. Sectorally, at 95% specificity, the sensitivity of RNFLT ranged from 31% to 59%, of BMO-HRW ranged from 35% to 64%, and of BMO-MRW ranged from 54% to 79%. Globally and in all sectors, BMO-MRW performed better than MRA1 or MRA2. The higher sensitivity at 95% specificity in early glaucoma of BMO-MRW compared with current BMO methods is significant, indicating a new structural marker for the detection and risk profiling of glaucoma. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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              Longitudinal change detected by spectral domain optical coherence tomography in the optic nerve head and peripapillary retina in experimental glaucoma.

              To investigate whether longitudinal changes deep within the optic nerve head (ONH) are detectable by spectral domain optical coherence tomography (SDOCT) in experimental glaucoma (EG) and whether these changes are detectable at the onset of Heidelberg Retina Tomography (HRT; Heidelberg Engineering, Heidelberg, Germany)-defined surface topography depression. Longitudinal SDOCT imaging (Spectralis; Heidelberg Engineering) was performed in both eyes of nine rhesus macaques every 1 to 3 weeks. One eye of each underwent trabecular laser-induced IOP elevation. Four masked operators delineated internal limiting membrane (ILM), retinal nerve fiber layer (RNFL), Bruch's membrane/retinal pigment epithelium (BM/RPE), neural canal opening (NCO), and anterior lamina cribrosa surface (ALCS) by using custom software. Longitudinal changes were assessed and compared between the EG and control (nonlasered) eyes at the onset of HRT-detected surface depression (follow-up 1; [FU1]) and at the most recent image (follow-up 2; [FU2]). Mean IOP in EG eyes was 7.1 to 24.6 mm Hg at FU1 and 13.5 to 31.9 mm Hg at FU2. In control eyes, the mean IOP was 7.2 to 12.6 mm Hg (FU1) and 8.9 to 16.0 mm Hg (FU2). At FU1, neuroretinal rim decreased and ALCS depth increased significantly (paired t-test, P < 0.01); no change in RNFL thickness was detected. At FU2, however, significant prelaminar tissue thinning, posterior displacement of NCO, and RNFL thinning were observed. Longitudinal SDOCT imaging can detect deep ONH changes in EG eyes, the earliest of which are present at the onset of HRT-detected ONH surface height depression. These parameters represent realistic targets for SDOCT detection of glaucomatous progression in human subjects.
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                Author and article information

                Journal
                Clin Ophthalmol
                Clin Ophthalmol
                Clinical Ophthalmology
                Clinical Ophthalmology (Auckland, N.Z.)
                Dove Medical Press
                1177-5467
                1177-5483
                2014
                25 June 2014
                : 8
                : 1203-1208
                Affiliations
                [1 ]Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
                [2 ]Advanced Medical Research Center, Aichi Medical University, Nagakute, Aichi, Japan
                Author notes
                Correspondence: Masahiro Zako, Department of Ophthalmology, Aichi Medical University, Nagakute, 480-1195 Aichi, Japan, Tel +81 561 62 3311, Fax +81 561 63 7255, Email zako@ 123456aichi-med-u.ac.jp
                Article
                opth-8-1203
                10.2147/OPTH.S62521
                4077864
                25028533
                4ac92a4b-bcbd-4d7e-b4b4-37bcf34edbdf
                © 2014 Mizumoto et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Original Research

                Ophthalmology & Optometry
                bruch’s membrane opening-minimum rim width,glaucoma,retinal nerve fiber layer thickness,rim area,spectral domain optical coherence tomography,visual field

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