Re: Kim et al.: Diagnostic classification of macular ganglion cell and retinal nerve fiber layer analysis: differentiation of false-positives from glaucoma (Ophthalmology 2015;122:502-10)

The new Bruch’s membrane opening – minimum rim width classification improves optical coherence tomography specificity in tilted discs

“…Similar to previous studies, a significant association between both axial length and spherical equivalent and GCIPL FP rate was found 4–7. In fact, the specificity using GCA was higher in eyes with non/low myopia compared with moderate myopia including and without including map deviation (62.0% vs 33.3%, P =0.085, and 86.2% vs 47.6%, P =0.005, respectively).…”

“…Several reasons have been reported to explain discrepancies in the FP rates which were observed in previous studies 7. Longer axial length has been significantly associated with an increased incidence of FPs on RNFL and GCA analyses 4–6.…”

“…The association among tilted disc, myopia, and longer axial length is well known, and recent studies have suggested that the degree of myopic optic disc tilt is correlated with the peripapillary RNFL characteristics measured by the Cirrus HD OCT in healthy individuals 7–10. Therefore, the challenge of distinguishing otherwise healthy myopic eyes with tilted disc from those afflicted with glaucoma is complex.…”

“…Recently, longer axial length has been significantly associated with an increased incidence of false-positives (FPs) on ganglion cell analysis (GCA) and RNFL maps after uni- and multivariate analyses 3–7. Caution is recommended in moderate myopic individuals because a high percentage can be misclassified as abnormal by RNFL and GCA Cirrus OCT maps 4…”

“…Axial length, mean spherical equivalent, presence of peripapillary atrophy, and tilted disc were significantly related to the RNFL FP occurrence displayed by both the devices; therefore, the degree of myopic optic disc tilt should be considered when interpreting the RNFL thickness measured by OCT 5,7–10. Clinical features of tilted disc overlap with other conditions, such as myopic disc and glaucoma, but the role of conventional OCT imaging technologies for the optic nerve head (ONH) is limited 4,5…”