In Vivo Evaluation of Focal Lamina Cribrosa Defects in Glaucoma

Kiumehr, Saman; Park, Sung Chul; Dorairaj, Syril; Teng, Christopher C.; Tello, Celso; Liebmann, Jeffrey M.; Ritch, Robert

doi:10.1001/archopthalmol.2011.1309

Cited by 153 publications

(176 citation statements)

References 37 publications

(47 reference statements)

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“…[17][18][19] The current study showed that SS-OCT at 1050 nm allowed 3D imaging of the whole lamina structures including the structure beneath the neuroretinal rim. Lamina cribrosa defects were thus found only by the EDI-OCT (in earlier studies) 20,21 and SS-OCT at 1050 nm (current study), probably because they were located at or in the vicinity of the lamina cribrosa margins beneath the neuroretinal rim. However, it remains difficult to visualize the laminar structure beneath retinal blood vessels because of signal loss due to vascular shadowing, 26 which must be taken into consideration for evaluation of hyporeflective lesions including lamina cribrosa defects (Fig.…”

Section: Discussionsupporting

confidence: 38%

“…[17][18][19] Recently, the EDI-OCT method was successfully used in the discovery of a local abnormality of lamina cribrosa, termed focal lamina cribrosa defect, which was associated with local glaucomatous optic disc changes such as neuroretinal rim thinning/notching or acquired pits of the optic nerve (APONs). 20,21 This interesting feature has not been reported in the earlier histopathological articles on glaucomatous eyes.…”

mentioning

confidence: 63%

“…Kiumehr et al 21 originally reported five categories of focal lamina cribrosa defects based on shape: smooth indentation, moth-eaten appearance defect, step-like depression, hole-like defect, and altered laminar insertion. However, the same research group included hole-like defects (laminar holes) and prominently altered laminar insertions (laminar disinsertions) to assess the association between lamina cribrosa defects and neuroretinal rim loss and APON because they aimed to avoid misclassification of normal anatomical variations and artifacts as real glaucomatous focal lamina cribrosa defects by using stricter criteria.…”

Section: Discussionmentioning

confidence: 99%

“…Kiumehr et al 21 showed that focal lamina cribrosa defects corresponded with glaucomatous optic disc changes such as neuroretinal rim thinning/notching or an APON. Park et al also showed a spatial correlation between focal lamina cribrosa defects and disc hemorrhages as well as neuroretinal rim loss and RNFL defects (Park SC, et al IOVS 2012;53:ARVO EAbstract 3695).…”

Section: Discussionmentioning

confidence: 99%

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Three-Dimensional Imaging of Lamina Cribrosa Defects in Glaucoma Using Swept-Source Optical Coherence Tomography

Takayama

Hangai

Kimura

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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Section: Discussionsupporting

confidence: 38%

mentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Three-Dimensional Imaging of Lamina Cribrosa Defects in Glaucoma Using Swept-Source Optical Coherence Tomography

Takayama

Hangai

Kimura

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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“…The significant association between tilted discs and papillomacular bundle defects in our study may support this speculation. The following two recent studies showed focal lamina cribrosa defects associated with VF defects in eyes with glaucoma and in eyes with pathologic myopia: Kiumehr et al 33 reported that focal lamina cribrosa defects detected in eyes with glaucoma spared the temporal and nasal 458 sectors, but Ohno-Matsui et al 34 reported that 31.6% of lamina cribrosa defects (acquired optic nerve pits) found in high myopia were located along the temporal edge of the lamina cribrosa, indicating that this area may be susceptible to mechanical stress in high myopia. Further studies regarding these mechanisms would be worthwhile.…”

Section: Discussionmentioning

confidence: 99%

Retinal Nerve Fiber Layer Defects in Highly Myopic Eyes with Early Glaucoma

Kimura¹,

Hangai²,

Morooka³

et al. 2012

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To compare the retinal nerve fiber layer (RNFL) defects in early glaucomatous eyes between highly and nonhighly myopic eyes.METHODS. Sixty-one highly myopic eyes (< À6.0 diopters [D]) of 61 patients and 55 non-highly myopic eyes of 55 patients with early visual field (VF) defects were studied. The angular locations and widths of the RNFL defects were measured from red-free fundus photographs. The RNFL defect closest to the fovea was designated the ''nearest RNFL defect'' of each hemisphere.RESULTS. In total, 131 RNFL defects were found in highly myopic eyes and 82 in non-highly myopic eyes. Twenty-seven (44.3%) of the 61 highly myopic eyes, but only 8 (14.5%) of the 55 non-highly myopic eyes had their nearest RNFL defects between 08 and 108 (P < 0.001). Although the frequencies of paracentral scotomas were comparable between the two groups, the rate of inferotemporal paracentral scotomas was significantly higher in the high myopia group (P ¼ 0.02). The numbers of nearest RNFL defects in the superior hemisphere or extending over both hemispheres were significantly higher in the high-myopia group. Multiple logistic regression analyses showed that high myopia and the nearest RNFL defect involving the papillomacular bundle were significantly associated with paracentral scotomas (odds ratio [OR]: 4.78, P < 0.05, and OR: 5.31, P < 0.001, respectively). High myopia was significantly associated with the nearest RNFL defect involving the papillomacular bundle (OR: 2.95, P < 0.05).CONCLUSIONS. These findings suggest that highly myopic eyes are more susceptible to papillomacular bundle damage in early glaucoma. (Invest Ophthalmol Vis Sci. 2012;53:6472-6478)

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Focal Lamina Cribrosa Defects Associated With Glaucomatous Rim Thinning and Acquired Pits

You

Park

et al. 2013

JAMA Ophthalmol

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Considering the potential clinical importance of focal lamina cribrosa (LC) defects as a characteristic structural feature in glaucoma and a risk factor for glaucomatous visual field progression, it may be helpful to know the structure of focal LC defects and the spatial relationship between them and glaucomatous optic disc changes such as neuroretinal rim thinning/ notching and acquired pits of the optic nerve (APON). Objective: To investigate structural and spatial relationships between focal LC defects and glaucomatous neuroretinal rim thinning/notching and APON. Design: In a cross-sectional analysis of data from an ongoing, prospective, longitudinal study, serial enhanceddepth imaging (EDI) optical coherence tomographic (OCT) images of the optic nerve head were obtained from patients with glaucoma and reviewed for focal LC defects (laminar holes or disinsertions). Anterior laminar insertion points and edges of laminar holes or disinsertions were marked in EDI-OCT images, reconstructed 3-dimensionally, and superimposed on optic disc photographs. Setting: A glaucoma referral practice. Participants: Two hundred thirty-nine eyes (120 patients) were examined. Fifty-four eyes were excluded because of an incomplete horizontal or vertical set of serial EDI-OCT images or poor-quality EDI-OCT images owing to media opacity, irregular tear film, or poor patient cooperation. Among the remaining 185 eyes, 40 (from 31 patients) had laminar holes or disinsertions and were included for analysis. Main Outcome Measures: Presence, extent, and location of laminar holes or disinsertions. Results: Among 185 eyes, 11 laminar holes and 36 laminar disinsertions were found in 40 eyes. Superimposed images of the 3-dimensionally reconstructed focal LC defects and disc photographs showed that the outline of the LC defect corresponded almost precisely to that of clinical APON for 6 laminar holes and that the LC defect was much larger than and enclosed APON for 10 laminar disinsertions. The remaining 5 laminar holes and 26 laminar disinsertions corresponded to focal neuroretinal rim loss, with no evidence of APON in disc photographs. Conclusions and Relevance: Focal LC defects (laminar holes or disinsertions) are associated with neuroretinal rim loss and APON. The extent of LC defects can be visualized more effectively on EDI-OCT images than by clinical examination.

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In Vivo Evaluation of Focal Lamina Cribrosa Defects in Glaucoma

Abstract: Mechanisms of LC deformation in glaucoma include focal loss of laminar beams, which may cause an acquired pit of the optic nerve in extreme cases.Focal LC defects occur in tandem with neuroretinal rim and visual field loss.

Cited by 153 publications

References 37 publications

Three-Dimensional Imaging of Lamina Cribrosa Defects in Glaucoma Using Swept-Source Optical Coherence Tomography

Three-Dimensional Imaging of Lamina Cribrosa Defects in Glaucoma Using Swept-Source Optical Coherence Tomography

Retinal Nerve Fiber Layer Defects in Highly Myopic Eyes with Early Glaucoma

Focal Lamina Cribrosa Defects Associated With Glaucomatous Rim Thinning and Acquired Pits

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