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Christy A. Hardin, Hongli Yang, Roujin Ren, Stuart K. Gardiner, Cindy L. Blachly, Michael Whitworth, Brad Fortune, Shaban Demirel, Claude F. Burgoyne; Enhanced Correlation Between Retinal Nerve Fiber Layer Thickness (RNFLT) and the Spectral Domain Optical Coherence Tomography (SDOCT) derived Neuroretinal Rim Parameter "Bruch’s Membrane Opening Minimum Rim Area" (BMO-MRA) in Human Ocular Hypertension and Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2821.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the correlations between two SDOCT optic nerve head (ONH) rim area parameters, Heidelberg Retinal Tomography Rim Area (HRT-RA) and several SDOCT RNFLT and RNFL crossectional area (RNFLA) parameters in 119 ocular hypertension and glaucoma patients.
Participants underwent HRT and SDOCT (Heidelberg Spectralis, 870nm) ONH and RNFL imaging (48 high-resolution, ONH centered, radial B-scans and one circle scan) on the same day. Data from one eye per patient was chosen randomly. For each SDOCT ONH data set, every 2nd (24) radial B-scan was manually delineated and the following parameters were quantified: 1) BMO minimum rim area (BMO-MRA); and 2) BMO-horizontal rim area (BMO-HRA). RNFLT and RNFLA were calculated from the circle scan, from a circle 1700μm from the BMO centroid or 950μm from BMO. Random effects models were constructed to assess the correlations between BMO-MRA, BMO-HRA, HRT-RA and each measure of RNFLT/RNFLA.
The mean rim area was 1.16 ± 0.31mm2 using SDOCT BMO-MRA, 1.23 ± 0.35 using SDOCT BMO-HRA and 1.54 ± 0.32 mm2 using HRT. The correlation between the SDOCT BMO-MRA and HRT rim area measures was 0.50. The correlations of SDOCT BMO-MRA with all RNFL measures ranged from 0.66 to 0.72 and were significantly larger (p<0.001 in all cases, Steiger’s Z2* statistic) compared with the correlations achieved using SDOCT BMO-HRW (0.38 to 0.50). BMO-MRA correlations were also larger (p<0.05 in all cases, Steiger’s Z2* statistic) than those achieved using HRT-RA (0.20 to 0.29). There were no significant differences between the correlations achieved using different SDOCT measures of RNFLT/RNFLA.
Our data suggest BMO-MRA is a better predictor of retinal nerve fiber layer status than HRT-RA and BMO-HRA. Current ONH rim assessment techniques (HRT-RA and BMO-HRA) lack a solid anatomical basis for two reasons: 1) the clinical disc margin (HRT-RA) is not a reliable outer border of rim tissue due to clinically invisible BM extensions [Reis, et al, Ophthalmology. In Press]; and 2) the measurement that is made is not perpendicular to the greatest number of axons.
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