Characteristics of Patients Showing Discrepancy Between Bruch’s Membrane Opening-Minimum Rim Width and Peripapillary Retinal Nerve Fiber Layer Thickness

Abstract

Background: To investigate clinical characteristics of patients showing discrepancy between Bruch’s membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness. Correlation with the visual field (VF) was also inspected. Methods: In this prospective, cross-sectional study, 106 eyes (106 subjects) showing normal BMO-MRW classification but abnormal RNFL classification were included. All patients underwent confocal scanning laser ophthalmoscopy, spectral-domain optical coherence tomography, and standard automated perimetry. Results: Clinical characteristics were as follows: mean age: 52.79 ± 14.75 years; spherical equivalent (SE), −2.52 ± 3.48 diopter (D); SE < −5.0 D, 34 (32.1%) eyes; large disc (>2.43 mm2), 40.6%; small disc (<1.63 mm2), 12.5%; VF index, 96.72 ± 9.58%; mean deviation, −1.74 ± 3.61 dB; β-peripapillary atrophy (PPA), 96.2%; γ-PPA, 75.5%. Majority (86.1%) of these cases demonstrated normal (71.3%) or borderline (14.9%) on VF. Temporal and nasal RNFL showed significant differences among disc size subgroups (all p < 0.05). Nasal RNFL was significantly thicker in a large disc group than other subgroups. Temporal, superotemporal, inferotemporal, inferonasal RNFL, and superior RNFL peak location showed significant differences (all p < 0.05) among SE subgroups. Temporal RNFL was significantly thicker in the high myopia group than other subgroups. Conclusions: Temporalization of RNFL peaks in myopia and nasalization of RNFL peaks in large disc that display abnormal classifications might show normal classification of BMO-MRW. These findings of discrepancy between classifications should be considered in the diagnosis of early glaucoma.

Deep learning classification of early normal-tension glaucoma and glaucoma suspect eyes using Bruch’s membrane opening-based disc photography

“…A discrepancy between the clinical disc margin based on fundus photography and the BMO-based disc margin was noted in our study. It has been described in several previous studies, and initially by Chauhan et al ( 7 , 11 , 14 ). The discrepancy was also noted in our previous study, “Characteristics of Patients Showing Discrepancy Between Bruch’s Membrane Opening-Minimum Rim Width and Peripapillary Retinal Nerve Fiber Layer Thickness” ( 14 ).…”

“…Latest studies have shown that BMO-MRW demonstrated better diagnostic performance in glaucoma than preexistent NRR parameters ( 11 – 13 ). In our previous study, we reported that BMO-MRW might reveal normal color code classification, whereas the RNFL showed abnormal color code classification in cases of large discs and myopia ( 14 ). This previous study of ours suggested the clinical usefulness of BMO-MRW in early glaucoma or GS, particularly in cases of large disc and myopia when the diagnosis is difficult because conventional color code classification of RNFL may display false-positive results.…”

Variants in HNRNPH1 are associated with high myopia in humans and ocular coloboma in zebrafish

“…34,35 Such reductions were also identified in the global average thickness retinal fiber layer (RNFL) or peripapillary retinal nerve fiber layer (pRNFL) in the non-temporal topographic profiles in eyes with high myopia, [36][37][38] while RNFL was with significantly thicker in the temporal quadrant in eyes with high myopia than that in eyes with low myopes. 39,40 Additionally, the outer segment of receptors layer has been reported to be thicker in the high myopic group compared with the normal group. 41 The expression profile of HNRNPH1 in human retina provides evidence that it may be specifically affected the retinal cells in patients with high myopia.…”

“…The ganglion cell‐inner plexiform layer (GC‐IPL) thickness has been proved to be significantly thinner in highly myopia eyes than normal eyes or low myopia 34,35 . Such reductions were also identified in the global average thickness retinal fiber layer (RNFL) or peripapillary retinal nerve fiber layer (pRNFL) in the non‐temporal topographic profiles in eyes with high myopia, 36–38 while RNFL was with significantly thicker in the temporal quadrant in eyes with high myopia than that in eyes with low myopes 39,40 . Additionally, the outer segment of receptors layer has been reported to be thicker in the high myopic group compared with the normal group 41 .…”

Rate of Change in Bruch’s Membrane Opening-Minimum Rim Width and Peripapillary RNFL in Early Normal Tension Glaucoma

“…BMO-MRW also shows a better structure-function relationship in glaucoma than other pre-existing peripapillary RNFL and parameters of confocal scanning laser ophthalmoscope [ 10 , 11 , 12 , 13 ]. We have previously described a disagreement between BMO-MRW and RNFL in classification analysis of color-codes [ 14 ]. At early glaucomatous stage, structural changes are minimal.…”