Glaucoma Specialist Optic Disc Margin, Rim Margin, and Rim Width Discordance in Glaucoma and Glaucoma Suspect Eyes

Hong, Seung Woo; Koenigsman, Helen; Ren, Ruojin; Yang, Hongli; Gardiner, Stuart K.; Reynaud, Juan; Kinast, Robert; Mansberger, Steven L.; Fortune, Brad; Demirel, Shaban; Burgoyne, Claude F.

doi:10.1016/j.ajo.2018.04.022

Cited by 30 publications

(20 citation statements)

References 48 publications

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“…This could lead to a variation of bPPA -BM width. 40 However, we used infrared fundus images as an adjunct for the clinical disc margin, and in that way, we found a good interobserver agreement for measurement of bPPA -BM . Recently, the anterior scleral canal opening (ASCO) was introduced as a stable anatomic landmark, although it is often challenging to segment ASCO accurately.…”

Section: Discussionmentioning

confidence: 81%

“…20 Second, this study is limited by its cross-sectional design and recruitment of patients from a hospital outpatient clinic, and therefore might not be adequate for representation of a general population. Third, it should be noted that the clinical disc margin has no consistent anatomic foundation 40,41 ; this region falls inside the OCT-derived BMO, and is either bare sclera or border tissues of Elschnig or some combination of the two. This could lead to a variation of bPPA -BM width.…”

Section: Discussionmentioning

confidence: 99%

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Peripapillary Choroidal Vascularity Index and Microstructure of Parapapillary Atrophy

Suh

Park

Khandelwal

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To investigate the association between the microstructure of b-zone parapapillary atrophy (bPPA) and choroidal vascularity index (CVI) determined by spectral-domain optical coherence tomography (SD-OCT) in glaucomatous eyes. METHODS. A total of 160 eyes of 160 primary open-angle glaucoma patients with bPPA were included. Total choroidal area (TCA), luminal area (LA), and CVI were measured at a 3.5-mm distance from the Bruch's membrane (BM) opening center by image binarization of SD-OCT B-scans. The widths of bPPA with BM (bPPA þBM) and without BM (bPPA-BM), and juxtapapillary choroidal thickness (JPCT) were measured on six radial SD-OCT images. OCT angiography-derived parapapillary deep-layer microvasculature dropout (MvD_P) was also derived. RESULTS. In the multivariate regression analysis, larger bPPA þBM was significantly associated with smaller TCA and smaller LA (P < 0.05, respectively), but not with CVI and JPCT (P > 0.05, respectively). Meanwhile, bPPA-BM was not significantly associated with TCA, LA, CVI, or JPCT in the multivariate regression analysis (P > 0.05). CONCLUSIONS. Despite significant relationship between the choroidal thinning and larger bPPA þBM , choroidal vascularity was not associated with the bPPA þBM width. These findings suggest that the presumed common pathogenic mechanism between RPE atrophy and peripapillary choroidal thinning may not be mediated by the impaired choroidal perfusion in glaucomatous eyes. Future studies on the mechanisms in explaining the relationship between the atrophy of retinal pigment epithelium (RPE) and choroid in glaucoma are needed.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Peripapillary Choroidal Vascularity Index and Microstructure of Parapapillary Atrophy

Suh

Park

Khandelwal

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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“…[20][21][22] Frequently, the innermost extension of Bruch's membrane beyond the border tissues is invisible to the clinician, making disc margin-based ''disc size'' estimates inaccurate. [20][21][22] FIGURE 1. OCT optic nerve head (ONH) and neural canal landmarks from the left eye of study subject FDA 287 shown in right eye orientation.…”

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confidence: 99%

OCT-Detected Optic Nerve Head Neural Canal Direction, Obliqueness, and Minimum Cross-Sectional Area in Healthy Eyes

Hong

Yang

Gardiner

et al. 2019

American Journal of Ophthalmology

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To assess anterior scleral canal opening (ASCO) offset relative to Bruch's membrane opening (BMO) (ASCO/BMO offset) so as to determine neural canal direction, obliqueness, and minimum crosssectional area (NCMCA) in 362 healthy eyes. DESIGN: Cross-sectional study. METHODS: After optical coherence tomography optic nerve head and retinal nerve fiber layer thickness (RNFLT) imaging, BMO and ASCO were manually segmented. Planes, centroids, size, and shape were calculated. Neural canal direction was defined by projecting the neural canal axis vector (connecting BMO and ASCO centroids) onto the BMO plane. Neural canal obliqueness was defined by the angle between the neural canal axis and the BMO plane perpendicular vector. NCMCA was defined by projecting BMO and ASCO points onto a neural canal axis perpendicular plane and measuring the area of overlap. The angular distance between superior and inferior peak RNFLT was measured, and correlations between RFNLT, BMO, ASCO, ASCO/ BMO offset, and NCMCA were assessed. RESULTS: Mean (SD) NCMCA was significantly smaller than either the BMO or ASCO area (1.33 (0.42), 1.82 (0.38), 2.22 (0.43) mm 2 , respectively), and most closely correlated to RNFLT (P < .001, R 2 [ 0.158). Neural canal direction was most commonly superior-nasal (55%). Mean neural canal obliqueness was 39.4 8 (17.3 8). The angular distance between superior and inferior peak RNFLT correlated to neural canal direction (P £ .008, R 2 [ 0.093). CONCLUSIONS: ASCO/BMO offset underlies neural canal direction, obliqueness, and NCMCA. RNFLT is more strongly correlated to NCMCA than to BMO or ASCO, and its peripapillary distribution is influenced by neural canal direction.

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“…The disc margin does not correspond to a unique anatomical structure but to a complex interaction of structures (i.e., border tissue, anterior scleral opening, and BMO). 18 , 32 Different examiners may have different impressions on the disc margin location, which may produce somewhat different results. However, the center of optic disc, obtained by two independent observers, showed excellent reliability.…”

Section: Discussionmentioning

confidence: 99%

Angular Location of Retinal Nerve Fiber Layer Defect: Association With Myopia and Open-Angle Glaucoma

Bak

Lee

Kim

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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Purpose To compare retinal nerve fiber layer (RNFL) defects’ angle measurements determined from the center of the optic disc and Bruch's membrane opening (BMO), as a function of myopia and open-angle glaucoma (OAG) subtypes. Methods In total, 118 patients with OAG were grouped by axial length (AL; high myopia, AL >26 mm; mild to moderate myopia, 24 ≤ AL ≤26 mm; nonmyopia, AL <24 mm) and OAG subtype (normal-tension glaucoma [NTG], high-tension glaucoma [HTG]). The disc and BMO centers were determined by a merged image of red-free fundus photography and spectral-domain optical coherence tomography. The angular location of the RNFL defect close to the fovea (angle α) was measured from the disc center and BMO center, respectively (angle α disc and angle α BMO ). The difference between angle α disc and α BMO (Δα), as well as the RNFL defect width (angle γ), was evaluated. Results Angle α disc was smaller in myopic eyes and correlated significantly with AL ( P = 0.001), whereas it did not differ among OAG subgroups. Angle α BMO and angle γ were not different in the myopic and OAG subgroups. The Δ α was larger for eyes with higher degree of myopia and had significant correlation with AL ( P < 0.001) and was larger in NTG eyes than in HTG eyes ( P = 0.023). Conclusions The angular location of the RNFL defect measured from the disc center, but not from the BMO center, was closer to the fovea for glaucomatous eyes with higher values of AL. The present study may facilitate understanding of the characteristic locational pattern of the RNFL defect in myopic glaucomatous eyes.

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Glaucoma Specialist Optic Disc Margin, Rim Margin, and Rim Width Discordance in Glaucoma and Glaucoma Suspect Eyes

Abstract: In this study, glaucoma specialist RM, DM, and RW discordance was frequent and substantial, even in sectors that were suspicious for rim thinning.

Cited by 30 publications

References 48 publications

Peripapillary Choroidal Vascularity Index and Microstructure of Parapapillary Atrophy

Peripapillary Choroidal Vascularity Index and Microstructure of Parapapillary Atrophy

OCT-Detected Optic Nerve Head Neural Canal Direction, Obliqueness, and Minimum Cross-Sectional Area in Healthy Eyes

Angular Location of Retinal Nerve Fiber Layer Defect: Association With Myopia and Open-Angle Glaucoma

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