Clinical application of Optovue RTVue OCI' and Heidelberg Retina Tomograph Ⅲ in early diagnosis of glaucoma / 中华实验眼科杂志

Background Many studies showed that attenuation of retinal nerve fiber layer(RNFL)in early glaucoma is one of the important signs.How to accurately and quantitatively measure RNFL thickness is very important for the early diagnosis and monitoring of glaucoma.0bjective This study was to evaluate the clinical value of Optovue RTVue OCT and Heidelberg Retina Tomograph Ⅲ(HRT-Ⅲ)confocal scanning laser ophthalmoscopy in glaucomatous eyes. Methods This cross-sectional study included 40 eyes of 26 patients with suspected open-angle glaucoma(SOAG),48 eyes of 29 patients with open-angle glaucoma and 48 eyes of 27 healthy subjects.Optical nerve head(ONH) parameters and peripapillary RNFL thickness were measured in all the subjects with Optovue RTVue OCT and HRT-Ⅲ,meanwhile all the eyes received perimetry with Humphrey 750-I.Glaucoma variables obtained from Optovue RTVue OCT and HRT-Ⅲ were analyzed among the groups.Topographic Optovue RTVue OCT and HRT-Ⅲ parameters,including disc area(DA),cup area(CA),rim area(RA),rim volume(RV),cup volume(CV),cup/disc area ratio(C/DAR)as well as superior,temporal,inferior and nasal average RNFL thickness,were analyzed.The relationship of ONH parameters and RNFL thickness was analyzed using a linear correlation.The correlation between the mean defect(MD)of the visual field and the tomography parameters in glaucomatous eyes was described by bivariate Pearson correlation coefficients.Resuits The ONH parameters and RNFL thickness obtained by HRT-Ⅲ and OCT showed significant difference(P<0.05).ONH parameters such as RA,C/DAR,CA and RV were statistically changed in SOAG and the POAG patients compared with the normal subjects(q=6.47,q=7.67,P<0.05).The superior and inferior RNFL thickness parameters in three groups were positively correlated between HRT-Ⅲand OCT(r=0.362,r=0.441,r=0.395,P<0.05),Topographic Optovue RTVue OCT and HRT-Ⅲ parameters including CV,CA,RA and C/DAR fitted Pearson analysis(all P<0.05).In POAG group。The RA,RV,CV,C/DAR from Optovue RTVue OCT were correlated with MD with the significant coefficient 0.284,0.286,0.340,0.371 respectively(P<0.05),and evidently correlations also were found between RA,RV,C/DAR with MD respectively with the coefficient 0.339,0.859,0.422(P<0.05)by HRT-Ⅲ. Conclusion Both Optovue RTVue OCT and HRT-Ⅲ can difierentiate ONH analysis with a similar outcome in glaucomatous eye.The C/D value.RA,superior and inferior RNFL thickness based on Optovue RTVue OCT and HRT-Ⅲare distinguishing indexes in the diagnosis of early glaucomatous damage.

Accuracy of Optic Disc Parameters Obtained by the Heidelberg Retina Tomograph in the Diagnosis of Glaucoma

PURPOSE: To determine which optic disc topographic parameters, obtained by the Heidelberg Retina Tomograph (HRT), are most useful to distinguish normal eyes from those with early to moderate glaucomatous visual field defects. METHODS: From each of 92 normal subjects and 154 patients with primary open-angle glaucoma one randomly selected eye was studied. The Humphrey perimeter, program C 30-2 visual fields, and 13 HRT parameters (software 2.01, includes rim to disc area ratio) were utilized. Because some of the optic disc parameters depend on the optic disc area, these parameters were corrected for the effect of disc area. The total glaucoma group was divided into three subgroups according to the visual field defects: early (mean deviation [MD] >-6 dB, 65 eyes), moderate (MD -6 to -12 dB, 49 eyes), and severe (MD <-12 dB, 40 eyes) glaucoma groups. RESULTS: In eyes with early glaucoma (MD = -3.43 +/- 1.60 dB), the sensitivity, specificity, accuracy, and areas under the receiver operating characteristic curve were, respectively: rim area (69%, 71%, 70%, 0.802), rim to disc area ratio (69%, 72%, 71%, 0.799), cup area (72%, 70%, 71%, 0.789) and cup to disc area ratio (69%, 70%, 69%, 0.790). In eyes with moderate glaucoma (MD = -8.75 +/- 1.88 dB), they were, respectively: rim area (78%, 86%, 83%, 0.872), rim to disc area ratio (76%, 86%, 82%, 0.869), cup area (76%, 87%, 83%, 0.864) and cup to disc area ratio (78%, 84%, 82%, 0.862). There was considerable overlap in HRT parameters between the normal and early glaucoma groups. CONCLUSIONS: The diagnostic value of single optic disc parameter had its limitations in the diagnosis of early stage glaucoma.

The Influence of Age, Gender, Refractive Error, and Optic Disc Area on the HRT Parameters in Normal Eyes

PURPOSE: To study the influence of age, gender, refractive error, and optic disc size on the optic disc parameters measured with the Heidelberg Retina Tomograph (HRT; software 2.01) in normal eyes. METHODS: Ninety-two normal subjects (mean refractive error +/- SD: -0.15 +/- 1.64 D, range -6.63 to +3.38 D) were examined using HRT. The influence of age, refraction, and disc area on each parameter was analysed by multiple linear regression. RESULTS: Large discs had large values of cup area, cup volume, rim area, cup to disc area ratio, and mean cup depth. Large discs had small values of rim to disc area ratio. However, rim volume, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and retinal nerve fiber layer cross-sectional area were not related to disc area. Most parameters were independent of age or refractive error except for a few parameters. Age was weakly related to disc area. Refractive error was weakly associated with cup shape measure. Gender had no statistically significant influence on optic disc parameters. CONCLUSIONS: These results indicate that several optic disc parameters have better correlations with the optic disc area than age, gender, and refractive error. These differences must be considered in the evaluation of optic disc for glaucoma.

Correlation Between Disc Hemorrhage and Peripapillary Atrophy in Glaucoma Patients with Unilateral Disc Hemorrhage

PURPOSE: To investigate the correlation of peripapillary atrophy with disc hemorrhage in glaucoma patients with a unilateral disc hemorrhage METHODS: A retrospective review was performed on the medical records of 36 glaucoma patients (7 with primary open-angle glaucoma and 29 with normal-tension glaucoma) with a unilateral disc hemorrhage during a mean follow-up period of 25 months. Topographic measurements were performed with Heidelberg Retina Tomograph (HRT) within three months of detection of a disc hemorrhage. The parameters of zone beta of peripapillary atrophy were analyzed by the atrophy zone analysis program and compared with the fellow eyes. RESULTS: The area, angular and radial extent of zone beta, and ratio of zone beta area to disc area were significantly greater in the hemorrhagic eyes than in the contralateral eyes. The difference of refractive error, intraocular pressure, MD and CPSD of visual fields was not found to be significant between both eyes. CONCLUSIONS: The area and extent of peripapillary atrophy was significantly greater in the eyes with disc hemorrhage compared to the contralateral control eyes. This study suggested quantitatively that the peripapillary atrophy is associated closely with disc hemorrhage in glaucoma patients.

Quantitative Analysis of Diabetic Macular Edema after Laser Photocoagulation

PURPOSE: Diabetic macular edema is one of major causes leading to visual loss and it is difficult to be quantified. We investigated a volumetric quantification of retinal thickness change before and after focal laser photocoagulation with Heidelberg Retina Tomograph (HRT). METHODS: Ten patients who were diagnosed as diabetic retinopathy with clinically significant macular edema (CSME) in only one eye and treated with focal laser photocoagulation were studied. The opposite eyes which had no CSME were studied as control group. In the eyes which had CSME, the volume above reference plane (VARP) bounded by three consecutive circle centered at the fovea (diameter 1, 2, and 3 mm) were measured. The retinal thickness of control group was also measured with the same method. We performed focal laser photocoagulation for the eyes which had CSME and measured VARP at 1, 2, and 3 months after laser treatment. RESULTS: Three months after laser treatment, the VARP of treated eyes measured in each diameter was significantly decreased, however, there was no significant difference in control group. There was no significant difference in visual acuity change between before and 3 months after laser treatment. CONCLUSION: From the above results, we concluded that HRT could be used to quantify the change of diabetic macular edema before and after laser treatment.

Quantification of Diabetic Macular Edema with Heidelberg Retina Tomograph

Diabetic macular edema is a major cause of visual loss and it is difficult to be quantified.We investigated a method of assessment and volumetric quantification of diabetic macular edema with Heidelberg Retina Tomograph[HRT].Ten normal eyes of control group and 20 eyes with diabetic patients were studied.In 20 diabetic patients, 10 patients had macular edema and 10 patients had no macular edema. Macular edema was defined as any visible macular thickening within a circle centered at the fovea with 6mm in diameter. With HRT, the volumes above reference plane[VARP]bound by three consecutive circles centered at the fovea [diameter, 1, 2, and 3mm ]were measured. Measurements were repeated three times, and mean measurements were used for the analysis. Diabetic eyes with macular edema had statistically greater VARP than diabetic eyes without edema[p0.05]. The sensitivity of HRT was 90%, and the specificity was 100%. The VARP measured using HRT was found to be linearly correlated with visual acuity expressed on a logMAR scale[p<0.05]. From the above results, we concluded that HRT could identify diabetic macular edema by volumetric analysis and indicated a good relationship of volumetric changes with visual acuity.

The Parameters of the Retinal Nerve Fiber Layer Measured with Confocal Scanning Laser Ophthalmoscope & Nerve Fiber Analyzer

Assessment of the optic nerve head or the retinal nerve fiber layer is essential for the early diagnosis and monitoring of glaucoma. We compared mean retinal nerve fiber layer[RNFL]thickness with Average, and compared RNFL CSA with Integral between Heidelberg Retina Tomograph[HRT] and GDx nerve fiber analyzer[GDx]at global, superior, inferior, nasal and temporal area. Mean RNFL thickness in HRT was significantly greater than Average in GDx at all quadrants[p<0.001], and correlated with Average at global, superior and inferior area[p<0.05]. RNFL CSA in HRT was significantly greater than Integral in GDx at superior, inferior and nasal quadrants[p<0.001], and correlated with Integral at superior and inferior quadrants[p<0.05]. In conclusion, the two parameters related to nerve fiber layer in HRT were measured greater than those in GDx. Correlations of the above parameters between HRT and GDx were mainly present at superior and inferior quadrant. These results may come from regional difference in measurement between HRT and GDx, and uncorrected disc tilting in HRT appears to have adverse effects on the correlations of the above parameters between HRT and GDx at nasal or temporal quadrant.

The Quantitative Evaluation of Optic Ne rve Head of Normal Tension Glaucoma

It is known that optic disc morphology is different between high tension glaucoma[HTG]and normal tension glaucoma[NTG]. We quantitatively evaluated optic nerve head by confocal scanning laser ophthalmoscope [CSLO]to determine if substantial morphological differences between the HTG and the NTG could be identified. 21 patients[21 eyes]in the early NTG and 32 patients[32 eyes]in the early HTG were matched for visual field defect[MD>-10dB].The optic nerve head was evaluated by Heidelberg Retina Tomograph[HRT]and 12parameters provided by HRT were compared between NTG and HTG. The mean age of patients was 56.6 +/-13.6 years in NTG and 48.9 +/-14.7 years in HTG, respectively[p>0.05].Mean MD was -5.4 +/-1.9dB in the NTG, -5.0 +/-2.5dB in the HTG, respectively[p>0.05]. Disc area was slightly lager in the NTG than in the HTG, but the difference did not reach statistical significance[p>0.05].The neuroretinal rim area was significantly larger in the NTG than in the HTG[p<0.05], whereas the mean cup depth was significantly smaller in the NTG than in the HTG[p<0.05].Among the 12 parameters, cup area, rim area, cup volume, mean cup depth, and maximum cup depth in the NTG had significant correlations with CPSD in the visual field index.These findings further support the hypothesis that there may be different mechanisms in the glaucomatous optic nerve damage.

The Relationship between the Mean Height of Contour of the Retinal Surface at the Temporal Disc Margin and the Reference Height in Analyzing Optic Disc using Heidelberg Retina Tomograph

The relationship between the amount of posterior displacement of the retinal surface at the temporal disc margin and the reference height(HRef)in analyzing optic disc using Heidelberg Retina Tomograph(HRT;Heidelberg Engineering, Heidelberg, Germany)was evaluated. The displacement was measured as mean height of contour(MHC)in the temporal 40degrees C segment(20degrees C superior and 20degrees C inferior to the horizontal midline)of optic disc. HRef is a value representing the location of the standard reference plane. The accordances of HRef and stereometric parameters between right and left disc were also evaluated. MHC in the temporal 40 degrees C and nasal 40 degrees C segment, HRef, and stereometric parameters of optic disc were measured with the HRT in 244 eyes of 122 subjects. HRef was 0.376+/-0.099 mm in the right disc and 0.385+/-0.090 mm in the left disc. There was good correlation between HRef and MHC in the temporal 40degrees C segment(r=0.97, p<0.01), but poor in the nasal 40 degrees C segment(r=0.29, p<0.01). The accordances of HRef and stereometric parameters increased as the difference of MHC in the temporal 40degrees C segment between right and left disc decreased. HRef was affected by the amount of posterior displacement of the retinal surface at the temporal disc margin, which occurs in instances such as a tilted disc. We should find the method to adjust stereometric parameters to the amount of disc tilt.

The Changes of Sensory Retinal Detachment in Central Serous Choriore tinopathy Patients

Patients with central serous chorioretinopathy complain of decreased vision, micropsia, metamorphopsia, and central scotoma due to sensory retinal detachment. Morphologic characteristics of the sensory retinal detachment were described using Heidelberg retina tomograph. We inspected the changes in morphology according to certain time interval in 28 eyes and correlated them with the changes in visual acuity and symptoms. The mean width,length, height, area and volume of the detached sensory retina at initial examina- tion were 2.86 +/-1.08 mm, 2.60 +/-0.97mm, 0.30 +/-0.10mm, 6.82 +/-4.70mm2 and 0.77 +/-0.68mm3, respectively. Of the 7 eyes that had been followed, improvement of vision preceded improvement of other symptoms but, this was not statistically significant. The extent of sensory retinal detachment reduced with time and the maximal reduction occurred during the first month from the initial visit. The volume reduction (87.4%) was greater than the area reduction (52.3%) at the time of visual improvement

Quantitative Measurements of Neurosensory Retinal Detachment in Central Serous Chorioretinophathy

We performed this study to evaluate the quantitative three-dimensional measurements of neurosensory retinal detachment in central serous chorioretinopathy and the correlation among the type of leakage points on fluorescein angiography, initial visual acuity, the area and height of neurosensory retinal detachment. Types of leakage point were classified into ink-blot type (A) and smokestack type (B). Horizontal and vertical diameters, area, and maximal height of retinal detachment were measured by HRT (Heidelberg Retina Tomograph). Mean horizontal diameter was 3.69+/-1.00mm(range, 1.87~5.30mm), mean vertical diameter was 3.52+/-0.87mm(range, 1.77~4.88mm), mean area was 10.89+/-5.11 mm2(range, 4.29~21.50 mm2), and mean maximal height was 0.24+/-0.07mm(range, 0.10~0.36mm). Initial visual acuity of smokestack type was 0.39+/-0.25, and that of ink-blot type was 0.66+/-0.29. Initial visual acuity of smokestack type was statistically lower than that of ink-blot type. Area and maximal height or retinal elevation were 9.45+/-4.87 mm2, 0.23+/-0.08mm in type A and 13.41+/-4.77 mm2, 0.26+/-0.07mm in type B. The difference in area and maximal height of retinal elevation between type A and type B was not statistically significant. In smokestack type, initial visual acuity was significantly lowered as the area or the maximal height of retinal elevation increased, but the correlation was not statistically significant. In ink-blot type, no correlation was found between initial visual acuity and area or maximal height of retinal elevation.

Early Detection of Glaucoma with Retinal Nerve Fiber Layer Photograph

The purpose of this study was to evaluate the usefulness of retinal nerve fiber layer [RNFL] photography and Heidelberg Retina Tomograph [HRT, Heidelberg, Germany] in early detection of glaucoma. Among 2802 people who underwent routine health checkup at. Seoul National University Hospital from July I to Decernber 31, 1996, forty-nine persons were included whose IOP was above 21mmHg or cup/disc ratio was 0.5 or greater. RNFL photography, HRT and automated perimetry [Humphrey Field Analyzer, program C30-2] were performed. Twelve eyes were diagnosed as glaucoma and one sye as glaucoma suspect. Four eyes with glaucoma had RNFL defect with normal visual field and 7 eyes with glaucoma had both RNFL defect and glaucomatous visual field defect. Of 26 eyes suggested as glaucoma by FSM classification of HRT, only 8 eyes met the diagnostic cri-teria of glaucoma of this study. Among 21 eyes with decreased hump height in HRT only 7 eyes were diagnosed as glaucoma. RNFL photography increased the detection rate for glaucoma by 50% over that with visual field test. only. RNFL photography will be a valuable method for early detection of glaucorna while HRT may play a suppleinentary role.

Topographic Measurements of the Optic Nerve Head with Confocal Scanning Laser Tomography in Normal Subjects and Patients with Glaucoma

We analyzed the optic nerve head of 100 normal eyes with a confocal scanning laser tomograph(Heidelberg Retina Tomograph: HRT), and got the mean value of each parameter in HRT. We also examined 84 eyes of glaucoma patients. Glaucoma patients were divided into 3 groups according to decibel(dB) loss of mean defect on Humphrey visual field test(Central 30-2 program; Group 1:less than 5dB, group 2:between 5dB and 10dB. group 3:greater than 10dB). The mean value of the parameter in HRT are as follows: disk area, 2.35mm2; cup area, 0.48mm2; C/D ratio, 0.20; rim area, 1.86mm2; cup volume, 0.10mm2; rim volume, 0.55mm2; mean cup depth, 0.19mm; maximal cup depth, 0.59mm; cup shape measure, -0.23; height variation contour, 0.42; mean retinal nerve fiber layer thickness, 0.28mm; retinal nerve fiber layer cross sectional area, 1.52mm2. Comparing with normal subjects, group 1 patients had significant difference in cup area, C/D ratio, rim area, cup volume, rim volume, mean cup depth, maximal cup depth, cup shape measure, height variation contour, and mean retinal nerve fiber layer thickness. All glaucoma patients had significantly different value in all parameters. The comparison among each group of glaucoma patients showed significant difference in cup area, C/D ratio, rim area, cup volume, rim volume, cup shape measure, and mean retinal nerve fiber layer thickness.

Topographic Measurements of the Optic Nerve Head with Confocal Scanning Laser Tomography in Normal Subjects and Patients with Glaucoma

We analyzed the optic nerve head of 100 normal eyes with a confocal scanning laser tomograph(Heidelberg Retina Tomograph: HRT), and got the mean value of each parameter in HRT. We also examined 84 eyes of glaucoma patients. Glaucoma patients were divided into 3 groups according to decibel(dB) loss of mean defect on Humphrey visual field test(Central 30-2 program; Group 1:less than 5dB, group 2:between 5dB and 10dB. group 3:greater than 10dB). The mean value of the parameter in HRT are as follows: disk area, 2.35mm2; cup area, 0.48mm2; C/D ratio, 0.20; rim area, 1.86mm2; cup volume, 0.10mm2; rim volume, 0.55mm2; mean cup depth, 0.19mm; maximal cup depth, 0.59mm; cup shape measure, -0.23; height variation contour, 0.42; mean retinal nerve fiber layer thickness, 0.28mm; retinal nerve fiber layer cross sectional area, 1.52mm2. Comparing with normal subjects, group 1 patients had significant difference in cup area, C/D ratio, rim area, cup volume, rim volume, mean cup depth, maximal cup depth, cup shape measure, height variation contour, and mean retinal nerve fiber layer thickness. All glaucoma patients had significantly different value in all parameters. The comparison among each group of glaucoma patients showed significant difference in cup area, C/D ratio, rim area, cup volume, rim volume, cup shape measure, and mean retinal nerve fiber layer thickness.

Reproducibility of Optic Nerve Head Topographic Measurements with the Heidelberg Retina Tomograph

Laser scanning tomography is an accurate method for the three-dimentional assessment of the optic nerve head. But its topographic measurement should be highly reproducible for early diagnosis and follow-up of patients with glaucoma. The authors evaluated the reproducibility of optic nerve head topographic measurements by the Heidelberg retina tomograph(HRT). The mean standard deviation of height measurements and the mean coefficient of variation of each parameters were calculated on the 10 independent measurements in five normal eyes. The results showed that the mean standard deviation of height measurements was 29.19 microgram. The mean coefficient of variation of the cup area, rim area, rim volume, mean cup depth and the mean retinal nerve fiber layer thickness was under 10%. Optic nerve head topographic measurement by the HRT is highly reprooucible, which may help follow-up of glaucoma patients.

The Effect of Centrally Aligned Image Acquisition on the Reproducibility of Optic Nerve Head Topographic Parameters obtained with Heidelberg Retina Tomograph

To compare the effect of centrally aligned image acquisitions with that of roughly centered image acquisitions on the reproducibility of topographic parameters obtained with the Heidelberg Retina Tomograph. three optic nerve head images were acquired sequentially by the rough centration of live image on the monitor, after then another three images sequentially by the central alignment in five healthy eyes of five subjects. For the centrally aligned image acquisitions, the contour of the frozen live optic nerve head image of each eye was copied into the transparent film. The images were acquired when the margin of live image fitted the contour line on the film. The reliability coefficients of the parameters ranged from 59.4% to 98.2% by the rough centration and 89.7% to 98.7% by the the central alignment. The results indicate that centrally aligned image acquisition provide highly reproducible topographic data of optic nerve head.

The value of the Heidelberg retina tomograph-Ⅱ in detection of primary chronic angle-closure glaucoma / 眼科

Objective To evaluate the value of the Heidelberg retina tomograph - Ⅱ in detection of primary chronic angle-closure glaucoma(CACG) in a Chinese population, and to investigate the difference of parameters detected by HRT-Ⅱ between normal subjects and CACG patients. To evaluate the sensitivity and specificity of optic disk detection using Moorfields regression analysis (MRA) and linear discriminant function(LDF) of the HRT-Ⅱ in differentiating normal from CACG eyes. Design Prospective, comparative case series. Participants 64 eyes of 32 normal subjects and 77 eyes of 51 patients with CACG were studied. The normal subjects were ageand refraction-matched with the glaucoma patients. Methods The interventions consisted of optic disk imaged by means of HRT-Ⅱ and visual field (VF) detected with Oculus Twinfield perimetry. The CACG patients then were divided into two groups according to the VF discriminant standard and mean defect (MD) of Oculus Twinfield perimetry, the group with the glaucomatous VF defect and the group without VF defect. The optic disk was described with 14 optic disk parameters. The optic disc parameters between the normal and the patients were compared. The optic disks were also classified as "normal/borderline/outside normal limits" on the basis of MRA. The results from MRA and from LDF provided in the HRT-Ⅱ were compared. Main Outcome Measures Optic disk parameters, MD of the VF, the VF discriminant standard, the sensitivity and specificity of HRT-Ⅱ examination. Results Between the normal and CACG patients, differences of the most of optic disk parameters were significant statistically (P

To utilize reasonably the morphological and functional examinations for diagnosing macular diseases / 眼科

Advantages and disadvantages of morphologic and functional examinations for macular disease were reviewed. These examinations included optical coherence tomography(OCT), Heidelberg retina tomograph(HRT), and multifocal electroretinography (mfERG), etc. It is very important to improve ability of diagnosis and management of macular disease by choosing examination logically and integrating morphologic examination with functional examination on the basis of disease.