Enhanced Diagnostic Capability for Glaucoma of 3-Dimensional Versus 2-Dimensional Neuroretinal Rim Parameters Using Spectral Domain Optical Coherence Tomography

Abstract

Purpose To compare the diagnostic capability of 3-dimensional (3D) neuroretinal rim parameters with existing 2-dimensional (2D) neuroretinal and retinal nerve fiber layer (RNFL) thickness rim parameters using spectral domain optical coherence tomography (SD-OCT) volume scans Materials and Methods Design Institutional prospective pilot study. Study population 65 subjects (35 open angle glaucoma patients, 30 normal patients). Observation procedures One eye of each subject was included. SD-OCT was used to obtain 2D retinal nerve fiber layer (RNFL) thickness values and five neuroretinal rim parameters [i.e. 3D minimum distance band (MDB) thickness, 3D Bruch’s membrane opening-minimum rim width (BMO-MRW), 3D rim volume, 2D rim area, and 2D rim thickness]. Main outcome measures Area under the receiver operating characteristic (AUROC) curve values, sensitivity, specificity. Results Comparing all 3D with all 2D parameters, 3D rim parameters (MDB, BMO-MRW, rim volume) generally had higher AUROC curve values (range 0.770–0.946) compared to 2D parameters (RNFL thickness, rim area, rim thickness; range 0.678–0.911). For global region analyses, all 3D rim parameters (BMO-MRW, rim volume, MDB) were equal to or better than 2D parameters (RNFL thickness, rim area, rim thickness; p-values from 0.023–1.0). Among the three 3D rim parameters (MDB, BMO-MRW, and rim volume), there were no significant differences in diagnostic capability (false discovery rate > 0.05 at 95% specificity). Conclusion 3D neuroretinal rim parameters (MDB, BMO-MRW, and rim volume) demonstrated better diagnostic capability for primary and secondary open angle glaucomas compared to 2D neuroretinal parameters (rim area, rim thickness). Compared to 2D RNFL thickness, 3D neuroretinal rim parameters have the same or better diagnostic capability.

Artifact Rates for 2D Retinal Nerve Fiber Layer Thickness Versus 3D Neuroretinal Rim Thickness Using Spectral-Domain Optical Coherence Tomography

“…Previous studies have demonstrated that 3D MDB neuroretinal rim thickness has similar or better diagnostic capability for glaucoma compared to 2D RNFL thickness. 27 , 28 Taken together with our study, these findings suggest that 3D MDB neuroretinal rim thickness offers an advantage to traditional 2D RNFL thickness not only in improved diagnostic capability but also in the reduced need for repeat scanning or manual correction. Although there is a commercially available low-density protocol (BMO-MRW) that quantifies neuroretinal rim tissue, this paper may encourage SD-OCT companies to incorporate high-density protocols with associated software analysis so that clinical use of SD-OCT can reach its full potential for glaucoma care.…”

Comprehensive Glaucoma Imaging

“…A relatively new anatomical ONH parameter is Bruch's membrane opening minimal rim width (BMO-MRW), corresponding to the minimal distance between the BMO and the internal limiting membrane. BRO-MRW correlates well with VF functional decline and shows a similar ability to detect glaucomatous eyes compared with RNFL and ONH parameters [56,57].…”

Optical coherence tomography evaluation of the optic nerve head neuro‐retinal rim in glaucoma

“…It is likely that disc size has greater impact at the extremes, that is, for very small or very large discs or discs of highly myopic eyes . Other similar approaches based on minimum distance mapping have confirmed the advantages it provides for glaucoma diagnostics …”