Optical coherence tomography measurement of macular and nerve fiber layer thickness in normal and glaucomatous human eyes

Abstract

Purpose-To evaluate the hypothesis that macular thickness correlates with the diagnosis of glaucoma.Design-Cross-sectional study.Participants-We studied 367 subjects (534 eyes), including 166 eyes of 109 normal subjects, 83 eyes of 58 glaucoma suspects, 196 eyes of 132 early glaucoma patients, and 89 eyes of 68 advanced glaucoma patients.Methods-We used optical coherence tomography (OCT) to measure macular and nerve fiber layer (NFL) thickness and to analyze their correlation with each other and with glaucoma status. We used both the commercial and prototype OCT units and evaluated correspondence between measurements performed on the same eyes on the same days. Main Outcome Measure-Macular and NFL thickness as measured by OCT.Results-All NFL parameters both in prototype and commercial OCT units were statistically significantly different comparing normal subjects and either early or advanced glaucoma (P < 0.001). Inner ring, outer ring, and mean macular thickness both in prototype and commercial OCT devices were found to be significantly different between normal subjects and advanced glaucomatous eyes (P < 0.001). The outer ring was the only macular parameter that could significantly differentiate between normal and early glaucoma with either the prototype or commercial OCT unit (P = 0.003, P = 0.008, respectively). The area under the receiver operator characteristic (AROC) curves comparing mean NFL thickness between normal and advanced glaucomatous eyes was 1.00 for both the prototype and commercial OCT devices for eyes scanned on both machines on the same day. The Reprint requests to Joel S. Schuman, MD, New England Eye Center, Tufts University School of Medicine, 750 Washington St, Box 450, Boston, MA 02111. Joel S. Schuman and Gadi Wollstein shared equal parts in the preparation of the manuscript.Presented in part at the American Academy of Ophthalmology (AAO), Orlando, Florida, 1999. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2007 August 15. Published in final edited form as:Ophthalmology. 2003 January ; 110(1): 177-189. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptAROC comparing mean macular thickness in normal and advanced glaucomatous eyes scanned on both machines on the same day was 0.88 for the prototype OCT device and 0.80 for the commercial OCT.Conclusions-Both macular and NFL thickness as measured by OCT showed statistically significant correlations with glaucoma, although NFL thickness showed a stronger association than macular thickness. There was good correspondence between findings using both the prototype and commercial OCT units. Macular and NFL thickness measurements made with OCT may have usefulness in the clinical assessment of glaucoma.Glaucoma is a process in which a loss of retinal ganglion cells (RGCs) results in characteristic optic nerve and visual field abnormalities. Detection of glaucomatous damage is typically through observation of the optic nerve head and retinal nerve fiber layer (NFL) and measurem...

Combining Nerve Fiber Layer Parameters to Optimize Glaucoma Diagnosis with Optical Coherence Tomography

“…Based on the area under the receiver operating characteristic curve (AROC), some studies have shown the overall RNFL thickness average to be the best diagnostic parameter. 11,13,14,16,19 Other studies have shown the inferior 10,17,20 or superior 21 quadrant RNFL thickness average to be the best, in agreement with clinical observation that glaucomatous optic nerve damage seems to begin in the inferotemporal or superotemporal area. [22][23][24] It is logical that optimal glaucoma detection might best employ a combination of several parameters.…”

“…It will also be used in comparative studies with parameters generated by other instruments, such as scanning laser topography and scanning laser polarimetry. Previous comparative studies used only the best single parameter to evaluate the diagnostic performance of OCT. 10,11,13,14,16,17,[19][20][21] This underestimates the diagnostic power of OCT. The OSI combination will significantly improve OCT's diagnostic performance in both clinical studies and clinical practice.…”

“…Measurements of the circumpapillary RNFL are reproducible [7][8][9] and useful in the early diagnosis of glaucoma. [10][11][12][13][14][15][16][17][18][19] Stratus (Carl Zeiss Meditec, Inc., Dublin, CA) is the most widely used OCT system for glaucoma diagnosis. Stratus measures the RNFL thickness profile along a 3.4-mm-diameter circle around the optic disc.…”

Strategies to improve early diagnosis in glaucoma

“…Initial studies examining the role of macular thickness measurements in glaucoma found that quantification of full retinal thickness was helpful for glaucoma diagnosis (Giovannini et al, 2002;Greenfield et al, 2003;Guedes et al, 2003;Lederer et al, 2003;Leung et al, 2005;Medeiros et al, 2005b). Though as thickness of the outer retina is largely unchanged in glaucoma, inclusion of outer retinal layers, such as the outer plexiform layer, outer nuclear layer, and photoreceptor segment layers, may reduce the sensitivity with which glaucomatous damage can be detected.…”

Análise da relação entre espessura macular e espessura da camada de fibras nervosas

“…Apesar da grande maioria dos estudos terem avaliado o dano neural através da análise da CFNR peridiscal, trabalhos recentes demonstraram que a medida da espessura macular também pode ser importante para estimar o dano neural (5)(6) .…”