Pattern of Glaucomatous Neuroretinal Rim Loss

Jonas, Jost B.; Fernandez, M. C.; Stürmer, Jörg

doi:10.1016/s0161-6420(13)31694-7

Cited by 263 publications

(184 citation statements)

References 23 publications

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“…This is expected because glaucoma tends to damage the RNFL in the inferior quadrant more severely. 24 When a false positive is due to a single parameter, it is likely due to the inferior or superior parameters (5 and 1) but never to the overall (Fig 2). We suspect that these falsepositive misclassifications were caused by centration error during OCT scanning, as we frequently observe some degree of misalignment between the OCT scan circle and optic disc.…”

Section: Discussionmentioning

confidence: 99%

“…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. Using combinations of RNFL parameters to evaluate Stratus OCT detection of perimetric glaucoma, Budenz et al 11 determined that the best combinations of sensitivity and specificity seem to be any quadrants abnormal or clock hours abnormal at the fifth percentile level.…”

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confidence: 99%

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

Lu¹,

Wang²,

Varma³

et al. 2008

Ophthalmology

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Purpose-To identify the best combination of Stratus optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness parameters for the detection of glaucoma. Design-Observational cross-sectional study.Participants-Eighty-nine age-matched normal and perimetric glaucoma participants enrolled in the Advanced Imaging for Glaucoma Study.Methods-The Zeiss Stratus OCT system was used to obtain the circumpapillary RNFL thickness in both eyes of each participant. Right and left eye clock-hour data are analyzed together, assuming mirror-image symmetry. The RNFL diagnostic parameters were combined using either or-logic or and-logic approaches.Main Outcome Measures-Area under the receiver operating characteristic curve (AROC), sensitivity, and specificity are used to evaluate diagnostic performance.Results-Overall average RNFL thickness has the highest AROC value (0.89) of all single parameters evaluated, followed by the inferior and superior quadrants (0.88 and 0.86, respectively). The clock hours with the best AROC values are in the inferior and superior quadrants. The highest AROC (0.92) was achieved by the or-logic combination of overall, inferior, and superior quadrant RNFL thicknesses. The 3-parameter combination was significantly better than the overall average alone (P = 0.01) The addition of more quadrants or clock hours to the combination reduced diagnostic performance.Conclusions-The best stand-alone diagnostic strategy for Stratus OCT RNFL data is to classify an eye as glaucomatous if the overall, inferior quadrant, or superior quadrant RNFL thickness average is below normal.Glaucoma is an optic neuropathy characterized by irreversible loss of neural tissue and visual field (VF). Currently, definitive glaucoma diagnosis is based on VF testing. However, between 30% and 50% of the ganglion cells may be lost before abnormalities appear in perimetric Optical coherence tomography, first described by Huang et al, 4 is the only imaging modality with sufficiently fine depth resolution to measure the RNFL thickness directly. Measurements of the circumpapillary RNFL are reproducible 7-9 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. Based on the profile, the averages of overall, quadrant, and clockhour RNFL thickness are computed and displayed. At present, the clinician has no clear guideline on whether one, several, or all of these diagnostic parameters should be used in the clinical diagnosis of glaucoma. 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...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Lu¹,

Wang²,

Varma³

et al. 2008

Ophthalmology

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“…7 This should lead to a loss of applicability of the ISNT rule in glaucomatous eyes. This has been reported by Jonas et al, 11 who found that abnormally low rim inferior to temporal and superior to temporal rim width ratios due to this preferential loss of NRR can indicate glaucomatous damage in some ocular hypertensive eyes.…”

Section: Discussionmentioning

confidence: 99%

“…3 Glaucoma is characterized by a progressive thinning of the NRR, which while occurring in all sectors of the optic disc, is said to show a preferential predilection for the inferior pole, thus leading to a loss of the physiological rim shape so that the inferotemporal rim is no longer the thickest. [4][5][6][7] The purpose of the present study is to evaluate whether the ISNT rule as assessed on Confocal scanning laser tomography of the optic disc is applicable in Indian eyes and also to evaluate if the pattern of NRR area loss as quantified by the confocal scanning laser tomograph, Heidelberg retina tomography (HRT) II is predictive of early primary open-angle glaucoma (POAG).…”

Section: Introductionmentioning

confidence: 99%

Is the ISNT rule violated in early primary open-angle glaucoma—a scanning laser tomography study

Sihota

Srinivasan

Dada

et al. 2007

Eye

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Aims To evaluate the relevance of the ISNT rule with reference to the optic nerve head, in differentiating normal and early glaucoma eyes and neuroretinal rim (NRR) area ratios as measures of glaucomatous optic neuropathy by confocal scanning laser ophthalmoscopy (Heidelberg retina tomography (HRT) II). Methods The study included 136 control eyes and 63 eyes of early primary open-angle glaucoma. Each patient underwent a complete ophthalmic examination, HRT II (software 2.01) and achromatic automated perimetry using the Humphrey field analyzer Full threshold program 30-2 or 24-2. Topographic HRT parameters (disc area and rim area) were compared between the groups. To assess the statistical significance of differences between the study groups, the Student's t-test was used. Results The ISNT rule was applicable in 71% of normal eyes and 68% of early glaucoma eyes. The superior to inferior area ratio was 0.9670.01 in the normal group and 0.9070.02 in the glaucoma group. There was a loss of approximately a quarter of the NRR in the inferotemporal and superotemporal quadrants. The inferonasal sector showed the least loss of NRR (4.34%). Conclusion The inferior NRR is marginally wider than the superior NRR in about 2/3 of normal eyes, but could not be clinically appreciated in many of these. The characteristic configuration of a normal optic disc with the rim width being greatest in the inferior disc region followed by the superior disc region was maintained even in most patients with early glaucoma.

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“…In glaucoma, RNFL thickness of this specific location is supposed to be preserved until the advanced stage. 37 Therefore, glaucomatous changes of ONH can be evaluated properly based on this reference level. However, in eyes with band atrophy of the disc, in which the temporal rim height is decreased with relative sparing of the superior and inferior rim height, the reference plane is depressed due to the temporal rim thinning.…”

Section: Hrt Parameters In Optic Neuropathiesmentioning

confidence: 99%

Evaluation of optic nerve head configuration in various types of optic neuropathy with Heidelberg Retina Tomograph

Nagai-Kusuhara

Nakamura

Kanamori

et al. 2007

Eye

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Purpose To test whether Heidelberg Retina Tomograph (HRT) is applicable to assess the optic nerve head (ONH) configuration of the atrophic phase of non-glaucomatous optic neuropathy when a default set of the reference plane is used. Methods Ten eyes with non-arteritic anterior ischaemic optic neuropathy (NAION), 17 eyes with Leber's hereditary optic neuropathy (LHON), 40 eyes with compressive optic neuropathy (CON) owing to chiasmal tumour, and 241 eyes of control individuals were examined with HRT using the default reference plane. The global values of HRT parameters were evaluated among the groups of patients and controls. The sectoral measurements of the eyes with LHON and CON were compared with controls. To eliminate the influence of disc size and age on HRT measurements, eyes with disc area-and age-matched normal controls were used for comparison with eyes with NAION and LHON. Results Cup parameters in eyes with NAION were similar to those in controls. The retinal nerve fibre layer (RNFL) thickness was significantly thinner in eyes with NAION than that of controls. The eyes with LHON had significantly larger cup parameters, smaller rim volume, and thinner mean RNFL thickness than controls. Eyes with CON had significantly larger rim area and smaller cup parameters but similar RNFL thickness compared with controls. Conclusions When the default reference plane is used, HRT can measure the ONH configuration in eyes with NAION and LHON as expected. However, caution must be made to interpret the parameters obtained from the eyes with CON.

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Pattern of Glaucomatous Neuroretinal Rim Loss

Cited by 263 publications

References 23 publications

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

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

Is the ISNT rule violated in early primary open-angle glaucoma—a scanning laser tomography study

Evaluation of optic nerve head configuration in various types of optic neuropathy with Heidelberg Retina Tomograph

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