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Elise Taniguchi, Eleftherios I Paschalis, Dejiao Li, Haobing Wang, Stacey C. Brauner, Scott H. Greenstein, Angela V. Turalba, Louis R Pasquale, Lucy Q Shen; Prelaminar and Lamina Cribrosa Defects Detected by Swept Source OCT in Glaucoma Stratified by Visual Field Loss Pattern. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2056.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate quantitative and qualitative prelaminar and lamina cribrosa defects, in healthy eyes and in open angle glaucoma (OAG) eyes, stratified by patterns of Humphrey visual field (HVF) loss.
Twenty-six OAG patients, with visual acuity better than 20/50, and no previous glaucoma surgeries were recruited to this study, along with seven age-matched healthy subjects. All participants underwent volume and radial scans of the optic nerve head by swept source optical coherence tomography (SS-OCT, Atlantis, Topcon). Two masked observers (LQS, EVT) reviewed all OCT images and identified prelaminar and lamina cribrosa defects. Qualitative prelaminar defects were classified into lacuna and wedge defects. Qualitative laminar defects comprised holes and disinsertions. Quantitative parameters, such as minimum rim width at Bruch’s membrane opening (BMO-MRW), vertical lamina cribrosa depth (LCD) and horizontal LCD, were measured using customized ImageJ plugins. HVF was classified into 3 categories based on objective criteria: isolated paracentral defect, isolated peripheral defect and combined paracentral-peripheral damage. Only one eye per patient was analyzed. One-way analysis of variance and independent t-test were used for group comparison.
The presence of wedge prelaminar defects among eyes with isolated paracentral defect on HVF was significant higher than among healthy eyes (50.0% vs. 0.0%; p=0.025) (Table). In addition, BMO-MRW in eyes with isolated paracentral defect was significantly lower than in eyes with early peripheral defect (p=0.016) and healthy eyes (p= 0.001). Eyes with combined paracentral-peripheral damage on HVF presented with significantly more lacunae in the prelaminar tissue than controls (83.3% vs. 14.3%; p=0.010). However, no statistically significant difference was found in the presence of laminar defects among controls (14.3%), isolated paracentral defect (40%), isolated peripheral defect (10%) and combined paracentral-peripheral damage (33.3%)(p>0.05). Likewise, neither vertical nor horizontal LCD was statistically different among the groups.
While larger sample sizes are needed, SS-OCT demonstrates that prelaminar pathology, as opposed to laminar pathology, predominates in eyes with OAG. Wedge prelaminar defect and lower BMO-MRW may be a SS-OCT structural biomarker for paracentral visual loss in OAG.
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