March 2012
Volume 53, Issue 14
Free
ARVO Annual Meeting Abstract  |   March 2012
Enhanced Glaucoma Detection With An Anatomically Accurate Spectral Domain OCT Derived Neuroretinal Rim Parameter
Author Affiliations & Notes
  • Balwantray C. Chauhan
    Ophthalmology & Visual Sciences,
    Dalhousie University, Halifax, Nova Scotia, Canada
  • Neil O'Leary
    Ophthalmology and Visual Sciences,
    Dalhousie University, Halifax, Nova Scotia, Canada
  • Faisal AlMobarak
    Ophthalmology & Visual Sciences,
    Dalhousie University, Halifax, Nova Scotia, Canada
  • Alexandre S. Reis
    Ophthalmology and Visual Sciences,
    Dalhousie University, Halifax, Nova Scotia, Canada
  • Hongli Yang
    Optic Nerve Head Research Lab, Devers Eye Institute, Portland, Oregon
  • Glen P. Sharpe
    Ophthalmology & Visual Sciences,
    Dalhousie University, Halifax, Nova Scotia, Canada
  • Donna M. Hutchison
    Ophthalmology & Visual Sciences,
    Dalhousie University, Halifax, Nova Scotia, Canada
  • Marcelo T. Nicolela
    Ophthalmology and Visual Sciences,
    Dalhousie University, Halifax, Nova Scotia, Canada
  • Claude F. Burgoyne
    Optic Nerve Head Research Lab, Devers Eye Institute, Portland, Oregon
  • Footnotes
    Commercial Relationships  Balwantray C. Chauhan, Carl Zeiss Meditec (R), Heidelberg Engineering (F, R); Neil O'Leary, None; Faisal AlMobarak, None; Alexandre S. Reis, None; Hongli Yang, None; Glen P. Sharpe, None; Donna M. Hutchison, None; Marcelo T. Nicolela, None; Claude F. Burgoyne, Heidelberg Engineering (F)
  • Footnotes
    Support  CIHR Grant MOP11357 (BCC); NEI Grant EY011610 (CFB)
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 1745. doi:
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      Balwantray C. Chauhan, Neil O'Leary, Faisal AlMobarak, Alexandre S. Reis, Hongli Yang, Glen P. Sharpe, Donna M. Hutchison, Marcelo T. Nicolela, Claude F. Burgoyne; Enhanced Glaucoma Detection With An Anatomically Accurate Spectral Domain OCT Derived Neuroretinal Rim Parameter. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1745.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose:
 

Rim assessment based on the clinical disc margin (DM) lacks a solid anatomical basis for two reasons. 1) the DM is not a reliable outer border of rim tissue due to clinically and photographically invisible extensions of Bruch’s membrane (BM) inside the DM1 and 2) rim tissue orientation in the ONH is unaccounted for. We introduced a parameter, BM opening-minimum rim width (BMO-MRW),2 that quantifies the rim from its true anatomical outer border and accounts for its variable trajectory in the measurement plane. Here we report its diagnostic capability.

 
Methods:
 

Glaucoma patients (n = 107) and normal controls (n = 48) had Spectralis SD-OCT imaging (24 B-scans centred on the optic nerve head). The median (IQR) age and mean deviation were 69.9 (64.3, 76.9) and 65.0 (58.1, 74.3) yrs, and -3.92 (-7.87, -1.62) and 0.33 (-0.32, 0.98) dB respectively. The internal limiting membrane (ILM) and BMO were manually segmented in all B-scans and two parameters (Fig 1) derived with custom software: 1) BMO-horizontal rim width (BMO-HRW), the distance between BMO and ILM in the BMO reference plane, akin to current BMO-based measurements and 2) BMO-MRW, the minimum distance between BMO and ILM. Global and 6 sectoral Moorfields Regression Analysis (MRA) from Heidelberg Retina Tomograph scans yielded MRA1 and MRA 2 where "borderline" was classified as normal and abnormal respectively. Diagnostic performance was evaluated in Receiver Operating Characteristics (ROC) space.

 
Results:
 

In controls, BMO-MRW was significantly more correlated to age than BMO-HRW (r = -0.26 and -0.06, P <0.01) or BMO area (r = -0.46 and -0.07, P < 0.01). Global BMO-MRW had consistently higher discrimination than global BMO-HRW (Fig 2). At 95% specificity, the sensitivity of BMO-MRW was 83% and BMO-HRW, 25%. Both MRA1 and MRA2 performed substantially worse. Sectorally, at 95% specificity, the sensitivity of BMO-MRW ranged 56-81%, and BMO-HRW, 10-46%. BMO-MRW performed better than MRA1 or MRA2 in all sectors.

 
Conclusions:
 

The >3-fold higher sensitivity at 95% specificity in early glaucoma of BMO-MRW compared to current methods is clinically significant, indicating a new structural marker for the detection and risk-profiling glaucoma.1Reis et al, Ophthalmology (in press)2Reis et al, submitted  

 
Keywords: optic disc • imaging/image analysis: clinical • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) 
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