Optic Disc Tilt Direction Determines the Location of Initial Glaucomatous Damage

Hwang

2016

Eye

Purpose To investigate the clinical characteristics according to the location of focal lamina cribrosa (LC) defects and its associated ocular features. Patients and methods A total of 139 openangle glaucoma patients underwent Spectralis optical coherence tomography (OCT) with enhanced depth imaging. Alterations in the contour of the LC were investigated to find focal LC defects. The location of the visible LC defect from the neural canal wall (farperipheral and mid-peripheral) and clockhour position (superotemporal, temporal and inferotemporal) were classified. Disc ovality ratio and disc-foveal angle were measured from disc and retinal nerve fiber layer (RNFL) photographs. The disc tilt degree was measured using a Heidelberg Retina Tomograph (HRT) III system. The en face OCT image of the disc scans was registered to the disc and RNFL photographs, to determine whether the focal LC defects corresponded spatially to the glaucomatous damage location. Results Eyes with far-peripheral LC defects were significantly myopic and had a higher disc ovality ratio. The disc tilt degree obtained by HRT revealed significant temporal disc tilt in eyes with temporal LC defects (Po0.001). Eyes with inferotemporal LC defects had a significantly larger discfoveal angle (P = 0.027). The inferotemporal LC defects corresponded to the location of glaucomatous damage in 81.6%; however, only 46.2% of eyes with a superotemporal LC defect and 3.2% of eyes with a temporal LC defect corresponded spatially with the glaucomatous damage location. Conclusions The clinical characteristics and association with glaucomatous damage location were different according to the location of focal LC defect.

Section: Subjectsmentioning

confidence: 99%

“…16,26 Topographic images were obtained through dilated pupils. The intrascan standard deviation was required to be o30 μm.…”

Section: Subjectsmentioning

confidence: 99%

Ocular characteristics associated with the location of focal lamina cribrosa defects in open-angle glaucoma patients

Hwang

2016

Eye

“…While prior to the clinical introduction of spectral-domain optical coherence tomography (OCT) the optic nerve head form was described according to its appearance upon two-dimensional ophthalmoscopy or on fundus photographs, OCT imaging now enables the three-dimensional assessment of the optic nerve head [2–7]. Previous studies have shown that using the OCT images allows the assessment of the rotation of the optic disc around the vertical axis, horizontal axis and sagittal axis [8].…”

Section: Introductionmentioning

confidence: 99%

Horizontal and vertical optic disc rotation. The Beijing Eye Study

et al. 2017

PurposeTo measure the optic disc rotation around the vertical and horizontal disc axis and to evaluate associations with general and ocular parameters.DesignPopulation-based studyMethodsIn the Beijing Eye Study, 3468 participants (mean age:64.6±9.8 years; range:50–93 years) underwent an ophthalmological examination which included spectral-domain optical coherence tomography (OCT) with enhanced depth imaging. Using the OCT images, we determined the amount of the rotation of the optic disc (defined as Bruch´s membrane opening (BMO)) around the vertical axis and horizontal axis.ResultsOptic disc rotation measurements were available for 3037 (87.6%) individuals. In multivariate analysis, larger optic disc rotation around the vertical axis (range:-4.90° to 41.0°) was associated (regression coefficient r:0.27) with high axial myopia (axial length ≥26.5 mm) (P<0.001;standardized regression coefficient beta beta:0.09), longer disc-fovea distance (P = 0.001;beta:0.09) and wider parapapillary beta/gamma zone (P<0.001;beta0.12). Larger optic disc rotation around the horizontal axis (range:-7.10° to 26.4°) was associated (r:0.32) with high axial myopia (P = 0.001;beta:0.08), larger optic disc-fovea angle (P<0.001;beta:0.13), thinner superior nasal retinal nerve fiber layer (RNFL) thickness (P<0.001;beta:-0.19) and thicker inferior nasal RNFL thickness (P<0.001;beta:0.17).ConclusionsVertical optic disc rotation was associated with highly myopic axial elongation, increased disc-fovea distance and development or enlargement of parapapillary, Bruch´s membrane free, gamma zone, while macular Bruch´s membrane length is not affected. Horizontal optic disc rotation was associated with inferior dislocation of the fovea, in addition to a thinner superior nasal RNFL and thicker inferior nasal RNFL. The latter association may be taken into account in the interpretation of RNFL thickness profiles.

American Journal of Ophthalmology

“…3–7 For example, retinal nerve fiber layer thickness has been shown to be related to vision loss in glaucoma, 8 and disc tilt has been associated with the location of initial glaucomatous damage. 5 …”

mentioning

confidence: 99%

Relationship Between Central Retinal Vessel Trunk Location and Visual Field Loss in Glaucoma

Wang

Pasquale

et al. 2017

PURPOSE To study the relationship between horizontal central retinal vessel trunk location (CRVTL) on glaucomatous optic discs and sector-specific visual field (VF) loss. DESIGN Retrospective cross-sectional study. METHODS CRVTL of 421 eyes from 421 patients was manually tracked on the horizontal optic disc axis on fundus images. Focal circumpapillary retinal nerve fiber layer thickness (cpRNFLT) measurements were extracted from optical coherence tomography (OCT). The relationship between focal visual field (VF) loss and CRVTL and focal cpRNFLT was studied by linear regression models. Furthermore, we related central VF loss to CRVTL and focal cpRNFLT separately for mild (VF mean deviation [MD] ≥−6 dB), moderate (−12 dB ≤ MD <−6 dB), and severe (MD <−12 dB) glaucoma. RESULTS CRVTL nasalization was significantly correlated only to central VF loss (Garway-Heath scheme [central 6 locations, C6]: correlation: r = −0.16, P < .001; macular vulnerability zone [central 2 locations, C2]: r = −0.14, P = .003; central 4 locations [C4]: r = −0.17, P < .001). While focal cpRNFLT at the sectors corresponding to C2 and C6 was significantly correlated to the respective VF sectors as well (C2: r = 0.15, P = .002; C6: r = 0.10, P = .03), multivariate models combining cpRNFLT and CRVTL substantially improved structure-function models compared with cpRNFLT alone (likelihood ratio tests, C2 and C6: P < .001). The correlations between CRVTL and central VF loss of C4 were −0.11 (P = .04), −0.39 (P = .01), and −0.63 (P = .002) for mild, moderate, and severe glaucoma, respectively. CONCLUSIONS CRVTL nasalization is significantly and exclusively correlated to central VF loss for all glaucoma severities independent of cpRNFLT, and thus might be a structural biomarker of central VF loss.