Purpose-To determine the effects of age, optic disc area, ethnicity, eye, gender, and axial length on the retinal nerve fiber layer (RNFL) in the normal human eye as measured by Stratus OCT (optical coherence tomography).Design-Cross-sectional observational study.Participants-Three hundred twenty-eight normal subjects 18 to 85 years old. Methods-PeripapillaryFast RNFL scans performed by Stratus OCT with a nominal diameter of 3.46 mm centered on the optic disc were performed on one randomly selected eye of each subject.Main Outcome Measures-Linear regression analysis of the effects of age, ethnicity, gender, eye, axial length, and optic disc area on peripapillary RNFL thickness.Results-The mean RNFL thickness for the entire population was 100.1 μm (standard deviation, 11.6). Thinner RNFL measurements were associated with older age (P<0.001); being Caucasian, versus being either Hispanic or Asian (P = 0.006); greater axial length (P<0.001); or smaller optic disc area (P = 0.010). For every decade of increased age, mean RNFL thickness measured thinner by approximately 2.0 μm (95% confidence interval [CI], 1.2-2.8). For every 1-mm-greater axial length, mean RNFL thickness measured thinner by approximately 2.2 μm (95% CI, 1.1-3.4). For every increase in square millimeter of optic disc area, mean RNFL thickness increased by approximately 3.3 μm (95% CI, 0.6-5.6). Comparisons between ethnic groups revealed that Caucasians had mean RNFL values (98.1±10.9 μm) slightly thinner than those of Hispanics (103.7±11.6 μm; P = 0.022) or Asians (105.8±9.2 μm; P = 0.043). There was no relationship between RNFL thickness and eye or gender.Correspondence to Donald L. Budenz, MD, MPH, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL 33136. dbudenz@med.miami.edu. Dr Schuman is currently at the Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr Schuman is a co-patent holder of the optical coherence tomography technology. Dr Patella is an employee of Carl Zeiss Meditec. Dr Quigley is a consultant for Carl Zeiss Meditec. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2010 August 5. Conclusions-Retinal nerve fiber layer thickness, as measured by Stratus OCT, varies significantly with age, ethnicity, axial length, and optic disc area. These variables may need to be taken into account when evaluating patients for diagnosis and follow-up of glaucoma, particularly at the lower boundary of the normal range. Due to the relatively small numbers of subjects of Asian and African descent in the normative database, conclusions regarding the effect of ethnicity should be interpreted with caution.Glaucoma is an optic neuropathy associated with accelerated apoptosis of retinal ganglion cells (RGCs) that manifests as increased cupping of the optic disc and thinning of the retinal nerve fiber layer (RNFL). The diagnosis of glaucoma is currently based on the appearance of the optic disc, RNFL, and standard achromatic perimetry. 1 The optic disc is ...

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The glaucomas are a group of relatively common optic neuropathies, in which the pathological loss of retinal ganglion cells causes a progressive loss of sight and associated alterations in the retinal nerve fiber layer and optic nerve head. The diagnosis and management of glaucoma are often dependent on methods of clinical testing that either, 1) identify and quantify patterns of functional visual abnormality, or 2) quantify structural abnormality in the retinal nerve fiber layer, both of which are caused by loss of retinal ganglion cells. Although it is evident that the abnormalities in structure and function should be correlated, propositions to link losses in structure and function in glaucoma have been formulated only recently. The present report describes an attempt to build a model of these linking propositions using data from investigations of the relationships between losses of visual sensitivity and thinning of retinal nerve fiber layer over progressive stages of glaucoma severity. A foundation for the model was laid through the pointwise relationships between visual sensitivities (behavioral perimetry in monkeys with experimental glaucoma) and histological analyses of retinal ganglion cell densities in corresponding retinal locations. The subsequent blocks of the model were constructed from clinical studies of aging in normal human subjects and of clinical glaucoma in patients to provide a direct comparison of the results from standard clinical perimetry and optical coherence tomography. The final formulation is a nonlinear structure-function model that was evaluated by the accuracy and precision of translating visual sensitivities in a region of the visual field to produce a predicted thickness of the retinal nerve fiber layer in the peripapillary sector that corresponded to the region of reduced visual sensitivity. The model was tested on two independent patient populations, with results that confirmed the predictive relationship between the retinal nerve fiber layer thickness and visual sensitivities from clinical perimetry. Thus, the proposed model for linking structure and function in glaucoma has provided information that is important in understanding the results of standard clinical testing and the neuronal losses caused by glaucoma, which may have clinical application for inter-test comparisons of the stage of disease.

Purpose-To determine the ability of optic nerve head (ONH) parameters measured with spectral domain Cirrus™ HD-OCT to discriminate between normal and glaucomatous eyes and to compare them to the discriminating ability of peripapillary retinal nerve fiber layer (RNFL) thickness measurements performed with Cirrus™ HD-OCT. Design-Evaluation of diagnostic test or technology.Participants-Seventy-three subjects with glaucoma and one hundred and forty-six age-matched normal subjects.Methods-Peripapillary ONH parameters and RNFL thickness were measured in one randomly selected eye of each participant within a 200×200 pixel A-scan acquired with Cirrus™ HD-OCT centered on the ONH.Main Outcome Measures-ONH topographic parameters, peripapillary RNFL thickness, and the area under receiver operating characteristic curves (AUCs).Results-For distinguishing normal from glaucomatous eyes, regardless of disease stage, the six best parameters (expressed as AUC) were vertical rim thickness (VRT, 0.963), rim area (RA, 0.962), RNFL thickness at clock-hour 7 (0.957), RNFL thickness of the inferior quadrant (0.953), vertical cup-to-disc ratio (VCDR, 0.951) and average RNFL thickness (0.950). The AUC for distinguishing between normal and eyes with mild glaucoma was greatest for RNFL thickness of clock-hour 7 (0.918), VRT (0.914), RA (0.912), RNFL thickness of inferior quadrant (0.895), average RNFL thickness (0.893) and VCDR (0.890). There were no statistically significant differences between AUCs for the best ONH parameters and RNFL thickness measurements (p > 0.05).Conclusions-Cirrus™ HD-OCT ONH parameters are able to discriminate between eyes that are normal from those with glaucoma or even mild glaucoma. There is no difference in the ability

Purpose: To compare the rates of detection of optic disc hemorrhages by clinical examination and by review of optic disc photographs at the Optic Disc Reading Center (ODRC), to assess the incidence of and the predictive factors for disc hemorrhages in the annual disc photographs of the Ocular Hypertension Treatment Study (OHTS), and to determine whether optic disc hemorrhages predict the development of primary open-angle glaucoma (POAG) in the OHTS.Design: Cohort study.Participants: 3,236 eyes of 1,618 participants. Methods:Both eyes of participants were examined for optic disc hemorrhages every 6 months by clinical examination, with dilated fundus examinations every 12 months, and by annual review of stereoscopic disc photographs at the ODRC. Main Outcome Measures:Incidence of optic disc hemorrhages and POAG endpoints.Results: Median follow-up was 96.3 months. Stereophotograph-confirmed glaucomatous optic disc hemorrhages were detected in 128 eyes of 123 participants prior to POAG. Twenty one (16%) were detected by both clinical examination and review of photographs and 107 (84%) only by review of photographs (P <0.0001). Baseline factors associated with disc hemorrhages were older age, thinner corneas, larger vertical cup/disc ratio, larger PSD index on perimetry, family history of glaucoma, and smoking. The occurrence of a disc hemorrhage increased the risk of developing POAG 6-fold in a univariate analysis, (p<0.001; 95% confidence interval 3.6 -10.1), and 3.7-fold in a multivariate analysis that included baseline factors predictive of POAG (p<0.001; 95% confidence interval 2.1 -6.6). The 96-month cumulative incidence of POAG in the eyes without optic disc hemorrhage was 5.2% compared to 13.6% in the eyes with optic disc hemorrhage. In eyes with a disc hemorrhage that developed a POAG endpoint, the median time between the two events was 13 months.Corresponding Author: Donald L. Budenz, MD, MPH, Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL 33136. Telephone 305−326−6384. FAX 305−326−6337. E-mail: dbudenz@med.miami.edu Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusion: Review of stereo photographs was more sensitive at detecting optic disc hemorrhage than clinical examination. The occurrence of an optic disc hemorrhage was associated with an increased risk of developing a POAG endpoint in participants in the OHTS. However, the majority of eyes (86.7%) that developed a disc hemorrhage have not developed a POAG endpoint to date.