Glaucoma Diagnostic Ability of the New Circumpapillary Retinal Nerve Fiber Layer Thickness Analysis Based on Bruch's Membrane Opening

Abstract

PURPOSE.To compare the diagnostic ability of the new spectral-domain optical coherence tomography (SD-OCT) algorithm for measuring circumpapillary retinal nerve fiber layer (RNFL) thickness centered on Bruch's membrane opening (BMO), with the conventional circumpapillary RNFL thickness measurement centered on the optic disc.METHODS. In 75 eyes with primary open-angle glaucoma (POAG) and 71 healthy control eyes, circumpapillary RNFL thickness was measured with SD-OCT, first by centering the scan circle on the optic disc (RNFL Di ), and then on the BMO (RNFL BMO ). Difference between the topographic profiles of RNFL Di and RNFL BMO was compared and factors influencing any discrepancies between methods were investigated. Glaucoma diagnostic abilities of each method were assessed using the areas under receiver operating characteristic curve (AUCs).RESULTS. Axial length did not differ between POAG and healthy eyes. A longer axial length and larger width of externally oblique border tissue (BT) associated with tilted optic disc were the two major factors influencing discrepancies between RNFL BMO and RNFL Di (both P < 0.001). Compared with RNFL BMO , RNFL Di tended to result in a thinner nasal RNFL in eyes with externally oblique BT, while RNFL BMO and RNFL Di were comparable in eyes without externally oblique BT. The glaucoma diagnostic capabilities were generally comparable, but RNFL BMO was superior to RNFL Di in eyes having a larger width (>250 lm) of externally oblique BT (AUC ¼ 0.933 vs. 0.843, respectively, P ¼ 0.027). CONCLUSIONS.The new circumpapillary RNFL scanning algorithm centered on BMO may provide a more reliable RNFL profile in eyes with tilted optic discs, with a largely comparable glaucoma diagnostic ability to the conventional algorithm.

The Impact of Lens Opacity on SD-OCT Retinal Nerve Fiber Layer and Bruch's Membrane Opening Measurements Using the Anatomical Positioning System (APS)

“…37 Defining the optic disc margins based on the BMO as a clear anatomic structure has been suggested to be more reliable and consistent. 2,20,[38][39][40] The APS of the Spectralis SD-OCT defines the optic disc based on the BMO and aligns the OCT scans accordingly. Hence, the discrepant findings between our and previous studies may be explained by our SD-OCT system using the APS.…”

“…Analyses of RNFLT are frequently used in glaucoma diagnostics [1][2][3] and hold promise as a biomarker for various neurodegenerative diseases. 4,5 Alterations and thinning of different retinal layers have been associated with neurologic diseases such as multiple sclerosis or Parkinson's disease.…”

Detecting Structural Progression in Glaucoma with Optical Coherence Tomography

“…A recent study has shown that although overall RNFL-BMO measurements have similar ability to detect glaucoma compared to traditional RNFL measurements, RNFL-BMO performed better in eyes with larger width externally oblique border tissue, a feature of titled optic discs. 41 There is however a lack of studies examining the long term reproducibly of RNFL-BMO and its ability to detect progression.…”

Bruch’s membrane opening enlargement and its implication on the myopic optic nerve head

“…Since the majority of structural diagnostic tools used to detect glaucoma are based on ONH evaluation, glaucoma diagnosis is difficult in myopic individuals with ONH deformation. In these patients, BMO-based parameters (e.g., BMO-MRW or BMO-based circumpapillary retinal nerve fiber layer [RNFL] thickness) have been proposed as good alternative diagnostic options 11–13 . Lee et al .…”