Bruch’s Membrane Opening Minimum Rim Width in the Differential Diagnosis of Optic Neuropathies

Braga, Joana; Soares, Ricardo Machado; Loureiro, Mónica; Ribeiro, Lígia; Meira, Dália

doi:10.1080/01658107.2019.1650075

Cited by 8 publications

(15 citation statements)

References 28 publications

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“…Some studies have highlighted that even when provided with color fundus photographs and automated perimetry exams, glaucoma specialists may misdiagnose non-glaucomatous optic neuropathies in 20-25% of patients [13,25]. CON is known to mimic the glaucomatous ONH cupping not only on fundoscopy examination but also in quantitative OCT, making it one of the most commonly missed diagnoses in favor of GON [14][15][16][17]. Therefore, finding feasible criteria to implement in routine glaucoma care is paramount to identify patients that would benefit from neuroimaging.…”

Section: Discussionmentioning

confidence: 99%

“…Over the years, optical coherence tomography (OCT) has emerged as a valuable noninvasive imaging tool for diagnosing and following optic neuropathies and retinal diseases. Consequently, new parameters based on Bruch's membrane opening minimum rim width (BMO-MRW) and circumpapillary retinal nerve fiber layer (cpRNFL) have been described to assist in the differential diagnosis of CON [14][15][16][17][18]. Most recently, macular analysis of the ganglion cell complex (GCC) through OCT proved significant in diagnosing GON [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

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Automated macular segmentation can distinguish glaucomatous from compressive optic neuropathy

Soares

Braga

Fernandes

et al. 2023

Graefes Arch Clin Exp Ophthalmol

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Purpose To compare macular damage in glaucomatous optic neuropathy (GON) and compressive optic neuropathy (CON) and assess its diagnostic accuracy in distinguishing between diseases. Methods Observational, cross-sectional, single-center study. Patients with GON, CON, and healthy controls were included according to the eligibility criteria. An automated spectral-domain optical coherence tomography (SD-OCT) algorithm was used to segment the circumpapilary retinal nerve fiber layer (cpRNFL) and macula. The layer thickness was measured in each sector according to the Early Treatment Diabetic Retinopathy Study and the 6-sector Garway-Heath-based grids. Data was compared across all study groups, and the significance level was set at 0.05. Results Seventy-five eyes of 75 participants, 25 with GON, 25 with CON, and 25 healthy controls (CG), were included. Macular thickness was diminished in the ganglion cell complex of GON and CON patients compared to CG (p<0.05). The best Garway-Heath-based grid parameters for distinguishing GON and CON were the nasal-inferior (NI) and nasal-superior sectors and the NI/temporal inferior (TI) damage ratios in the macular ganglion cell (mGCL) and inner plexiform (IPL) layers. Moreover, the combination of the NI sector and NI/TI damage ratios in both layers had higher discriminative power (AUC 0.909; 95% CI 0.830–0.988; p<0.001) than combining parameters in each layer separately. Conclusion Our findings suggest that the evaluation of macular segmented layers damage by SD-OCT may be a helpful add-on tool in the differential diagnosis between GON and CON.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Automated macular segmentation can distinguish glaucomatous from compressive optic neuropathy

Soares

Braga

Fernandes

et al. 2023

Graefes Arch Clin Exp Ophthalmol

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“…The diagnostic performance of this ratio herein is similar to that reported previously. Braga et al 17 found an AUROC of 0.86 using the global BMO-MRW/pRNFL ratio to discriminate glaucoma from a composite group of CONs, NAIONs and healthy subjects, whereas Leaney et al 18 found an AUROC of 0.95 using BMO-MRW values from all sectors. Combining the values from all sectors, as proposed by Leaney et al, 18 could help achieve better diagnostic performance, but its clinical use necessitates the composite's calculation by the OCT software.…”

Section: Discussionmentioning

confidence: 99%

Retinal Nerve Fiber Layer Thickness/Minimum Rim Width Ratio Differentiates Glaucoma From Other Optic Neuropathies

Boussion

Guindolet

Deschamps

et al. 2023

Journal of Glaucoma

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Précis: Global peripapillary retinal nerve fiber layer thickness (pRNFL)/Bruch membrane opening-minimum rim width (BMO-MRW) ratio is an objective and effective parameter to separate glaucomatous optic neuropathies (GONs) from nonGONs (NGONs).Purpose: This study was undertaken to evaluate the diagnostic capability of the pRNFL/ BMO-MRW ratio to differentiate GONs from NGONs.Patients and Methods: This retrospective study included patients with an optic neuropathy (ON), visual loss for > 6 months and a confirmed single etiology. pRNFL thickness and BMO-MRW were measured with spectral-domain optical coherence tomography (Spectralis, Heidelberg Engineering, Heidelberg, Germany). The diagnostic accuracies of pRNFL, BMO-MRW and the global pRNFL/BMO-MRW ratio were evaluated with the areas under receiver operating characteristics curves.Results: One eye each from 171 patients was investigated: 50 primary open angle glaucomas, 15 normal pressure glaucomas, 50 optic neuritises, 15 nonarteritic anterior ischemic ONs, 24 compressive ONs, 10 dominant optic atrophies, and 7 nutritional ONs. The global pRNFL/BMO-MRW ratio had the highest area under receiver operating characteristics curve [0.97 vs. 0.92; P = 0.01]. It was able to distinguish between GONs and NGONs with a cutoff value of 0.34. Increased mean deviation of the visual field-defect severity was associated with a higher ratio for GONs and a lower ratio for NGONs. Conclusion:Compared with NGONs and for the same degree of pRNFL thinning, lower BMO-MRW was found to be a specific marker of glaucoma, reflecting the neuroglial architecture changes within the optic nerve head typical of glaucoma and supporting fundamental pathophysiological differences.

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“…For example, one recent study has suggested that optic neuropathies other than glaucoma, including NAION, may be distinguished by an MRW that is within normal limits compared to thinning of the MRW observed in patients with glaucoma and a history of normal IOPs [ 20 ]. In another recent study, NAION patients and healthy subjects had similar MRW in all sectors, whereas glaucoma patients had significantly thinner MRW [ 21 ]. In this latter study, the peripapillary RNFL was not significantly different between the NAION and GON groups in all sectors.…”

Section: Discussionmentioning

confidence: 99%

Non-arteritic anterior ischemic and glaucomatous optic neuropathy: Implications for neuroretinal rim remodeling with disease severity

et al. 2023

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Purpose Post-acute non-arteritic ischemic optic neuropathy (NAION) and glaucomatous optic neuropathy (GON) can be difficult to differentiate clinically. Our objective was to identify optical coherence tomography (OCT) parameters to help differentiate these optic neuropathies. Methods We compared 12 eyes of 8 patients with NAION and 12 eyes of 12 patients with GON, matched for age and visual field mean deviation (MD). All patients underwent clinical assessment, automated perimetry (Humphrey Field Analyzer II; Carl Zeiss Meditec, Dublin, CA, USA), and OCT imaging (Spectralis OCT2; Heidelberg Engineering, Heidelberg, Germany) of the optic nerve head and macula. We derived the neuroretinal minimum rim width (MRW), peripapillary retinal nerve fibre layer (RNFL) thickness, central anterior lamina cribrosa depth, and macular retinal thickness. Results MRW was markedly thicker, both globally and in all sectors, in the NAION group compared to the GON group. There was no significant group difference in RFNL thickness, globally or in any sector, with the exception of the temporal sector that was thinner in the NAION group. The group difference in MRW increased with increasing visual field loss. Other differences observed included lamina cribrosa depth significantly greater in the GON group and significantly thinner central macular retinal layers in the NAION group. The ganglion cell layer was not significantly different between the groups. Conclusions The neuroretinal rim is altered in a dissimilar manner in NAION and GON and MRW is a clinically useful index for differentiating these two neuropathies. The fact that the difference in MRW between the two groups increased with disease severity suggests distinct remodelling patterns in response to differing insults with NAION and GON.

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Bruch’s Membrane Opening Minimum Rim Width in the Differential Diagnosis of Optic Neuropathies

Cited by 8 publications

References 28 publications

Automated macular segmentation can distinguish glaucomatous from compressive optic neuropathy

Automated macular segmentation can distinguish glaucomatous from compressive optic neuropathy

Retinal Nerve Fiber Layer Thickness/Minimum Rim Width Ratio Differentiates Glaucoma From Other Optic Neuropathies

Non-arteritic anterior ischemic and glaucomatous optic neuropathy: Implications for neuroretinal rim remodeling with disease severity

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