Lamina Cribrosa Depth in Different Stages of Glaucoma

Park, Sung Chul; Brumm, John; Furlanetto, Rafael; Netto, Camila; Liu, Yiyi; Tello, Celso; Liebmann, Jeffrey M.; Ritch, Robert

doi:10.1167/iovs.14-15540

Cited by 92 publications

(81 citation statements)

References 26 publications

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“…One investigation found deeper ALD with greater visual field loss in glaucoma patients, but no effect of age alone. 47,48 The baseline ALD is of less interest as a prognostic biomarker for glaucoma susceptibility than its dynamic mechanical properties. Human glaucoma eyes were stiffer by indirect clinical measures 49 and exhibit steeper stress-strain behavior in post mortem studies of the ONH 50 and sclera.…”

mentioning

confidence: 99%

Biomechanical Responses of Lamina Cribrosa to Intraocular Pressure Change Assessed by Optical Coherence Tomography in Glaucoma Eyes

Quigley

Arora

Idrees

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. The purpose of this study was to measure change in anterior lamina cribrosa depth (ALD) globally and regionally in glaucoma eyes at different intraocular pressures (IOP).METHODS. Twenty-seven glaucoma patients were imaged before and after IOP-lowering procedures using optical coherence tomography. The anterior lamina was marked in approximately 25 locations in each of six radial scans to obtain global and regional estimates of ALD. ALD and its change with IOP were compared with optic disc damage, nerve fiber layer thickness, and visual field loss. RESULTS.Variables associated with deeper baseline ALD included larger cup/disc ratio, thinner rim area, larger cup volume, thinner central corneal thickness, and male sex (all P 0.02). When IOP was lowered, ALD position became more anterior, more posterior, or was unchanged. The mean ALD change after lowering was 27 6 142 lm (P ¼ 0.3). The mean absolute value of ALD change was 112 6 90 lm (P ¼ 0.002). Change in ALD was greater in eyes with lower IOP in paired comparisons (P ¼ 0.006) but was not associated with the magnitude of IOP lowering between imaging sessions (P ¼ 0.94). Eyes with no significant change in ALD tended to have more visual field loss than those with significant anterior ALD displacement (P ¼ 0.07). Areas within each optic nerve head that corresponded to zones with thicker nerve fiber layer had greater ALD positional change (P ¼ 0.0007).CONCLUSIONS. The lamina can move either anteriorly or posteriorly with IOP decrease, with greater displacement at lower IOP. Glaucoma eyes and regions within glaucoma eyes associated with greater glaucoma damage exhibited smaller responses.Keywords: glaucoma, lamina cribrosa, optic nerve head, optical coherence tomography, intraocular pressure, biomechanics, stress A major site of damage to retinal ganglion cell (RGC) axons in glaucoma is the optic nerve head (ONH), within the lamina cribrosa.1-3 The biomechanical transmission of stress from intraocular pressure (IOP) produces strain in both the sclera and the ONH, 4-6 generating detrimental effects on RGC axons, ONH astrocytes, and nutritional blood flow in the nerve head. 7 The IOP level that produces RGC loss can be variable among individuals; some eyes suffer damage at IOPs that would be considered normal based on population studies, whereas many eyes with elevated IOP suffer no detectable damage. This suggests that the short-and long-term responses of scleral and ONH connective tissues to changes in IOP represent possible biomarkers for glaucoma incidence and progression. Normal lamina cribrosa structure is remodeled in glaucoma eyes, becoming deeper and wider 8 under the influence of a variety of factors, notably the stress of IOP as delivered through the sclera. 9 The regional differences in connective tissue density and pore size within the lamina cribrosa and greater regional strains suggest that the upper and lower poles of the ONH are weaker at resisting the stress of IOP in both human 10-14 and nonhuman primate eyes. 15 Indeed, these regions contain...

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confidence: 99%

Biomechanical Responses of Lamina Cribrosa to Intraocular Pressure Change Assessed by Optical Coherence Tomography in Glaucoma Eyes

Quigley

Arora

Idrees

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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“…Seo et al [7] investigated the characteristics of the LC depth in healthy eyes using EDI SD-OCT and their average ALCS depth was similar to our result (402 ± 101.46 μm). Park et al [30] reported a mean ALCD of 344 μm in healthy controls. However, these patients were younger (mean age: 56 years) than our population and, according to Ren et al [3] that suggested a shallower anterior LC in older eyes than in younger eyes, this age gap may explain this difference.…”

Section: Discussionmentioning

confidence: 98%

Intra- and Inter-Rater Agreement of Anterior Lamina Cribrosa Depth Measurements Using Enhanced-Depth Imaging Optical Coherence Tomography

Leal

Sousa²,

Pinto³

et al. 2016

Ophthalmic Res

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Purpose: To determine intra- and inter-rater agreement of anterior lamina cribrosa depth (ALCD) manual measurements using enhanced-depth imaging optical coherence tomography (EDI-OCT). Methods: Observational study. EDI-OCT of the optic nerve head was performed in healthy subjects. ALCD was defined as the perpendicular distance between the line connecting both edges of Bruch's membrane opening and the anterior border of the lamina cribrosa (LC), at the maximum depth point. Two experienced operators performed manual ALCD measurements of the LC independently, and one of the observers performed the same measurements twice. Intra- and inter-rater agreement was evaluated using intraclass correlation coefficients (ICC) and concordance correlation coefficients (CCC) for the right eye vertical (REV) and horizontal (REH) scans and left eye vertical (LEV) and horizontal (LEH) scans. Results: 120 eyes of 61 subjects, with a mean age of 62.1 ± 15.0 years. The mean REV, REH, LEV and LEH ALCD were 456.2 ± 84.3, 444.5 ± 92.2, 436.7 ± 81.6, 427.6 ± 82.7 μm, respectively. ALCD intra- and inter-rater ICC and intra- and inter-rater CCC varied between 0.85-0.95, 0.84-0.93, 0.85-0.95 and 0.84-0.93, respectively. Conclusions: ALCD manual intra- and inter-rater measurements with EDI-OCT showed high agreement. EDI-OCT is a reliable tool for ALCD measurement, which can provide potentially useful information for integrated glaucoma management.

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“…Although the measurement of LC depth seems to be plainer than that of LC thickness, it too may be problematic. Most studies set the reference point for LC depth as Bruch's membrane opening (BMO) [11,26]. Since myopic optic discs have experienced peripapillary changes, including posterior bowing of the BMO, or peripapillary atrophy (PPA) in the absence of BM [27,28], LC depth may vary according to the position of the BMO or the presence of BM.…”

Section: Discussionmentioning

confidence: 99%

Lamina cribrosa depth according to the level of axial length in normal and glaucomatous eyes

Yun

Hahn

Sung

et al. 2015

Graefes Arch Clin Exp Ophthalmol

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Lamina Cribrosa Depth in Different Stages of Glaucoma

Abstract: In treated glaucoma, posterior LC displacement occurs mostly in the preperimetric and mild-to-moderate glaucoma stages. This warrants further investigation of LC depth as a parameter to monitor glaucoma progression in the early stages.

Cited by 92 publications

References 26 publications

Biomechanical Responses of Lamina Cribrosa to Intraocular Pressure Change Assessed by Optical Coherence Tomography in Glaucoma Eyes

Biomechanical Responses of Lamina Cribrosa to Intraocular Pressure Change Assessed by Optical Coherence Tomography in Glaucoma Eyes

Intra- and Inter-Rater Agreement of Anterior Lamina Cribrosa Depth Measurements Using Enhanced-Depth Imaging Optical Coherence Tomography

Lamina cribrosa depth according to the level of axial length in normal and glaucomatous eyes

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