Comparison of macular GCIPL and peripapillary RNFL deviation maps for detection of glaucomatous eye with localized RNFL defect.

PURPOSE: To evaluate the ability of the deviation map of macular ganglion cell-inner plexiform layer (GCIPL) thickness compared with that of peripapillary retinal nerve fibre layer (pRNFL) thickness for detection of localized RNFL defects shown on red-free RNFL photography. METHODS: This prospective cross-sectional study included 69 eyes of 69 subjects with preperimetric or perimetric glaucoma (mean deviation (MD) >-12dB) and localized RNFL defects along with 79 eyes of 79 normal control subjects. The number of abnormal superpixels on the both macular GCIPL and pRNFL deviation maps by Cirrus OCT corresponding to localized RNFL defects was calculated using a customized Matlab program and presented as severity indices according to each of the probability levels. The areas under the receiver operating characteristic curves (AUROCs) of the severity indices were compared between the two deviation maps. RESULTS: According to three criteria and corresponding probability levels, the AUROCs of the GCIPL and pRNFL deviation maps ranged from 0.910 to 0.931 and 0.934 to 0.950, respectively. However, the differences were not statistically significant (all p > 0.05). Significant correlations were observed between the severity indices of the GCIPL deviation map and those of the pRNFL deviation map, regardless of the criteria (all p < 0.0001). CONCLUSIONS: In the detection of glaucomatous eyes with localized RNFL defects, the macular GCIPL thickness deviation map showed a level of diagnostic performance comparable to that of the pRNFL thickness deviation map.

Relative lens vault in subjects with angle closure.

BACKGROUND: The purpose of this study was to investigate the association of a novel biometric parameter, relative lens vault (LV), with primary angle-closure (PAC) and primary angle-closure glaucoma (PACG). METHODS: We evaluated 101 subjects with PAC (G) and 101 normal subjects that were age- and gender-matched. Based on anterior-segment optical coherence tomography scans, and using customized software, the anterior vault (AV) and LV were measured. They were defined as the maximum distances between the horizontal line connecting the two scleral spurs and the posterior corneal surface and anterior lens surface, respectively. The relative LV was calculated by dividing the LV by the AV. RESULTS: Significant differences between PAC (G) eyes and normal eyes were found in the LV (1.06 ± 0.41 vs. 0.36 ± 0.37 mm, P < 0.001), relative LV (0.34 ± 0.23 vs. 0.11 ± 0.25, P < 0.001), and axial length (22.96 ± 0.94 vs. 24.02 ± 1.33 mm, P < 0.001). However, the two groups' values of the AV relative to those of axial length were quite similar (both 0.14 ± 0.03, P = 0.91). The relative LV values distinguished between PAC (G) eyes and normal eyes better than the LV values (area under the receiver operator characteristic curve: 0.97 vs. 0.92, P = 0.032). CONCLUSIONS: Our results suggest that relative dimensions of the eyeball's anterior portion in PAC (G) eyes might be within the normal range. And the value of LV relative to that of the AV (i.e., the relative LV) is more closely related to PAC (G) than is the absolute value of LV.

Topographic localization of macular retinal ganglion cell loss associated with localized peripapillary retinal nerve fiber layer defect.

PURPOSE: To investigate the topographic relationship between ganglion cell-inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL) defects in open-angle glaucoma patients with localized RNFL defects, using spectral-domain optical coherence tomography (SD-OCT). METHODS: We analyzed 140 eyes of 140 patients showing a localized RNFL defect in one hemifield, the angular width of which was limited to one clock-hour sector. The RNFL and macular GCIPL scans were obtained using SD-OCT. The clock-hour location and width of pRNFL defects on the RNFL deviation map were determined, and their topographic association with corresponding GCIPL defects on the GCIPL deviation map was assessed. RESULTS: A "GCIPL deviation frequency map" demonstrating GCIPL defects corresponding to six different clock-hour locations of pRNFL defects was obtained, and it revealed the following specifics: (1) pRNFL defect at 12, 11, and 10 o'clock corresponded to GCIPL defect in the superior macula, as those at 8, 7, and 6 o'clock did to those in the inferior macula; (2) the overall GCIPL defect had an arcuate shape that appeared as a continuation of the pRNFL defect; (3) the temporal macular region was the frequently damaged site in either hemifield, and was larger in the inferior hemifield than in the superior hemifield. Additionally, an interindividual variability of GCIPL defect was noted for patients with the same clock-hour location of pRNFL defect. CONCLUSIONS: The GCIPL deviation frequency map demonstrating the topographic relationship between pRNFL and GCIPL defects was generated using SD-OCT. Our results indicated the topographic location of retinal ganglion cell death associated with clock-hour location of pRNFL loss in vivo.

Quantitative assessment of retinal nerve fiber layer defect depth using spectral-domain optical coherence tomography.

PURPOSE: To assess quantitatively the depth of retinal nerve fiber layer (RNFL) defects using a Cirrus high-definition (HD) optical coherence tomography (OCT)-derived RNFL thickness deviation map. DESIGN: Prospective, cross-sectional study. PARTICIPANTS: Three-hundred fifteen eyes with localized and diffuse RNFL defects of 315 glaucoma patients and 217 eyes of 217 healthy subjects. METHODS: For the glaucoma subjects, the severity of the RNFL defect was graded on red-free fundus photographs by 2 observers using a standardized protocol with a 3-level grading system. The RNFL defect depth on the RNFL thickness deviation map was expressed as an RNFL defect depth percentage index (RDPI): 100×(1-[summation of thicknesses of RNFL defects {red or yellow superpixels}/summation of RNFL thicknesses of upper 95th percentile range of age-matched healthy subjects in areas corresponding to RNFL defects]). MAIN OUTCOME MEASURES: Retinal nerve fiber layer defect depth percentage index, average and segmental (4 quadrants and 12 clock-hour sectors) circumpapillary RNFL (cpRNFL) thicknesses according to the RNFL defect severity, and the area under the receiver operating characteristic curves (AUROCs) for various OCT parameters. RESULTS: The RDPIs increased with the increasing severity of the RNFL defect in both the superior and inferior hemifields (P <0.05, 1-way analysis of variance test with Bonferroni correction). The AUROCs of the RDPIs (0.969 and 0.975 in the superior and inferior hemifields, respectively) were larger than those of all of the cpRNFL thicknesses in discriminating the mild from the moderate RNFL defects (P <0.05). Meanwhile, in discriminating the moderate from the severe RNFL defects, the AUROCs of the RDPIs (0.961 and 0.891 in the superior and inferior hemifields, respectively) were larger than those of the cpRNFL thicknesses in all areas except the inferior quadrant and the 6-, 7-, and 11-o'clock sectors (P <0.05). CONCLUSIONS: The RDPI, a new parameter using a Cirrus HD OCT-derived RNFL thickness deviation map, can be a useful adjunct tool for objective quantification of RNFL defect depth. This parameter has an advantage over cpRNFL thickness in discriminating between mild and moderate RNFL defects, not in discriminating between moderate and severe defects.

Topographic characteristics of optic disc hemorrhage in primary open-angle glaucoma.

PURPOSE: To investigate the topographic characteristics of optic disc hemorrhage (DH) and the factors associated with DH area in POAG. METHODS: We enrolled 128 POAG eyes (with DH) of 128 patients consecutively. Digital red-free retinal nerve fiber layer (RNFL) photographs and digital color stereo disc photographs of the enrolled eyes were reviewed, and the DH locations were measured. The DH area was calculated based on RNFL deviation map/RNFL photographs overlay image. RESULTS: Disc hemorrhages were most common in the inferotemporal inferior sector (58.0%) and the disc rim (40.6%) in terms of octant and proximal location, respectively. In a multivariate analysis, a larger DH area was associated with older age (P < 0.01), use of acetylsalicylic acid (P = 0.03), lower cup-to-disc ratio (P < 0.01), and lower baseline IOP (P = 0.01). In normal-baseline IOP-POAG eyes (n = 88), the overall DH area and length of maximum radial extent of DH were larger than in high-baseline IOP-POAG eyes (n = 40) (P = 0.04 and 0.03, respectively). CONCLUSIONS: In POAG eyes, DH was larger in area and longer in length in cases of normal-baseline IOP than in cases of high-baseline IOP. This suggests the possibility that previous studies' findings of higher DH prevalence and incidence in normal-baseline IOP-POAG eyes were partially affected by these topographic characteristics, which make DH more easily detectable.

Long-term reproducibility of cirrus HD optical coherence tomography deviation map in clinically stable glaucomatous eyes.

OBJECTIVE: To determine the long-term reproducibility of the retinal nerve fiber layer (RNFL) thickness deviation map in glaucoma patients. DESIGN: Retrospective, longitudinal study. PARTICIPANTS: One hundred two eyes of 102 glaucoma patients. METHODS: From a total of 318 screened glaucoma patients who had undergone at least 3 serial Cirrus HD optical coherence tomography sessions during an 18-month or longer follow-up period, 102 eyes with localized RNFL defects on red-free photographs that did not progress during this period based on stereoscopic disc photography, red-free photography, and standard automated perimetry (SAP) were included. The angular widths from the RNFL thickness deviation maps and average, clock-hour, and quadrant-map thicknesses of the RNFL defects were measured serially to assess intersession variability. MAIN OUTCOME MEASURES: Intraclass correlation coefficient (ICC), coefficient of variation (CV), test-retest standard deviation (TRT SD), and tolerance limit. RESULTS: The ICC, CV, and TRT SD were 0.994, 4.2%, and 1.46°, respectively, for the angular widths; 0.944, 3.1%, and 2.35 µm, respectively, for the average thicknesses; and 0.840 and 0.934, 7.8% and 6.4%, and 7.21 and 5.58 µm, respectively, for the superior and inferior quadrant positions of the RNFL defects. The severity of glaucoma based on the mean deviation of SAP did not affect the reproducibility of the angular widths (TRT SD, 1.3° and 1.84°, respectively; P = 0.905). CONCLUSIONS: Both the angular widths of RNFL defects in the RNFL thickness deviation map and conventional peripapillary thickness parameters exhibit excellent long-term reproducibility. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.